儿童侵袭性肺部真菌感染患者伏立康唑血药浓度与肝肾功能指标的关联性  

Correlation Between Serum Voriconazole Concentration and Hepatic and Renal Function Indices in Pediatric Patients with Invasive Pulmonary Fungal Infections

作　　者：陈辞 石迎迎 CHEN Ci;SHI Yingying(Henan Provincial People’s Hospital,People’s Hospital of Zhengzhou University,Zhengzhou 450000,China;the Fifth Clinical Medical College of Henan University of Chinese Medicine(Zhengzhou People’s Hospital),Zhengzhou 450000,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,河南郑州450000 [2]河南中医药大学第五临床医学院(郑州人民医院),河南郑州450000

出　　处：《河南医学研究》2024年第10期1745-1749,共5页Henan Medical Research

基　　金：河南省医学科技攻关计划项目(LHGJ20200679)。

摘　　要：目的 探讨伏立康唑血药浓度对肺部真菌感染患儿肝肾功能的影响,为临床合理用药提供参考。方法 回顾性分析河南省人民医院2021年8月至2022年8月肺部真菌感染患儿的临床资料,以伏立康唑血药浓度进行四分位数分层,比较各组年龄、肝、肾功能和联合用药等指标差异。结果 本次研究共入组103例儿童患者,测定的伏立康唑谷浓度中位值为2.59(0.21,13.74)mg·L^(-1),其中80例(77.67%)达到目标浓度范围(0.5~5.0 mg·L^(-1))。以伏立康唑血药浓度高低进行四分位数分层,共分为4组(Q_(1)~Q_(4)),Q_(1)组(26例)0.44(0.21,0.62 mg·L^(-1),Q_(2)组(26例)1.34(0.72,1.81)mg·L^(-1),Q_(3)组(26例)2.58(1.82,3.54)mg·L^(-1),Q_(4)组(25例)6.11(3.71,13.74)mg·L^(-1)。不同伏立康唑浓度分层组间的天冬氨酸氨基转移酶(AST)及间接胆红素(IBIL)比较,差异有统计学意义(P<0.05);而其他肝功能及肾功能指标组间比较,差异无统计学意义(P>0.05)。在女性患儿组中,不同伏立康唑浓度分层组间的IBIL比较,差异有统计学意义(P<0.05);在男性患儿组内肝功能指标AST不同组间差异有统计学意义(P<0.05)。男性伏立康唑浓度与肝功能指标AST存在正相关(P<0.05)。结论 儿童患者伏立康唑谷浓度及肝功能指标在男性中有差异,存在相关性,受浓度影响比较大,临床应用时应进行个体化给药,注意性别差异。Objective To explore the influence of serum voriconazole concentration on hepatic and renal function in pediatric patients with pulmonary fungal infections,providing reference for rational drug use in clinical practice.Methods A retrospective analysis was conducted on clinical data of pediatric patients with pulmonary fungal infections admitted to Henan Provincial People’s Hospital from August 2021 to August 2022.Serum voriconazole concentration was stratified by quartiles,and differences in age,hepatic and renal function,and concomitant medication were compared among groups.Results A total of 103 pediatric patients were included in this study.The median voriconazole trough concentration was 2.59(0.21,13.74)mg·L^(-1),with 80 cases(77.67%)achieving the target concentration range(0.5-5.0 mg·L^(-1)).Stratified by quartiles of serum voriconazole concentration,four groups(Q_(1)-Q_(4))were formed:Q_(1) group(26 cases)0.44(0.21,0.62)mg·L^(-1),Q_(2) group(26 cases)1.34(0.72,1.81)mg·L^(-1),Q_(3) group(26 cases)2.58(1.82,3.54)mg·L^(-1),and Q_(4) group(25 cases)6.11(3.71,13.74)mg·L^(-1).There were differences in aspartate aminotransferase(AST)and indirect bilirubin(IBIL)between different quartiles of voriconazole concentration(P<0.05),while other hepatic and renal function indices showed no statistically significant differences(P>0.05).In female pediatric patients,there were differences in IBIL between different quartiles of voriconazole concentration(P<0.05).In male pediatric patients,AST showed statistically significant differences between different quartiles of voriconazole concentration(P<0.05).There was a positive correlation between voriconazole concentration and AST in male patients(P<0.05).Conclusion Serum voriconazole concentration and hepatic function indices differ in male pediatric patients and are correlated,with a significant impact of concentration.Individualized dosing should be considered in clinical practice,with attention to gender differences.

关 键 词：真菌感染 伏立康唑 药物监测 血药浓度 

分 类 号：R725.6[医药卫生—儿科]