老年低蛋白血症患者发生伏立康唑相关肝损伤的独立危险因素分析  

Analysis of independent risk factors for voriconazole-related liver injury in elderly patients with hypoproteinemia

作　　者：周丽娟 何勐 张玮 王娜 李慧红 申明慧 靳巍巍 ZHOU Lijuan;HE Meng;ZHANG Wei;WANG Na;LI Huihong;SHEN Minghui;JIN Weiwei(Dept.of Pharmacy,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;General Office,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China)

机构地区：[1]郑州大学附属郑州中心医院药学部,郑州450007 [2]郑州大学附属郑州中心医院综合办公室,郑州450007

出　　处：《中国药房》2024年第24期3035-3040,共6页China Pharmacy

基　　金：河南省科技发展计划项目(No.222102310224);河南省医学科技攻关计划项目(No.LHGJ20191056,No.LHGJ20230777);河南省高等学校重点科研项目(No.21B360010)。

摘　　要：目的探讨老年低蛋白血症患者发生伏立康唑(VCZ)相关肝损伤的独立危险因素。方法选取2020年8月-2023年7月我院呼吸重症监护室使用VCZ治疗的侵袭性真菌感染的老年低蛋白血症患者,按用药后是否发生肝损伤分为A组(发生肝损伤)和B组(未发生肝损伤)。采用Pearson相关分析法分析VCZ谷浓度(cmin)与炎症因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)]、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)]的相关性;采用χ^(2)检验进行单因素分析;采用Logistic回归分析影响肝损伤发生的独立危险因素。结果纳入320例患者,有56例患者发生了肝损伤,肝损伤发生率为17.50%。A组患者的VCZ_(cmin)显著高于B组(P=0.021)。CRP、PCT、IL-6、TBIL与VCZ_(cmin)均存在相关性(P<0.05);CRP、PCT、IL-6、TBIL对VCZ_(cmin)有显著影响(P<0.05);VCZ_(cmin)、PCT、TBIL是影响肝损伤发生的独立危险因素(P<0.05);VCZ_(cmin)≥3.76 mg/L的患者肝损伤风险显著增加。结论VCZ_(cmin)、PCT、TBIL是影响老年低蛋白血症患者发生VCZ相关肝损伤的独立危险因素;对于PCT或TBIL高的患者,使用VCZ期间,应密切监测VCZcmin和肝功能,以降低肝损伤的发生风险。OBJECTIVE To explore the independent risk factors of voriconazole(VCZ)-related liver injury in elderly patients with hypoproteinemia.METHODS Elderly patients with invasive fungal infection and hypoproteinemia who were hospitalized in the respiratory intensive care unit of our hospital and treated with VCZ from August 2020 to July 2023 were selected.They were divided into group A(liver injury group)and group B(non-liver injury group)based on whether the liver injury occurred after using VCZ.Pearson correlation analysis was used to analyze the correlation between minimum concentration(cmin)of VCZ and inflammatory factor[C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)],as well as liver function[alanine transaminase(ALT),aspartate transaminase(AST),alkaline phosphatase(ALP),gamma-glutamyl transpeptidase(GGT),total bilirubin(TBIL)];univariate analysis was performed by usingχ^(2) test;Logistic regression analysis was used to analyze the independent risk factors affecting the occurrence of liver injury.RESULTS A total of 320 patients were included in the study,of whom 56 developed liver injury,with an incidence of 17.50%.The VCZ_(cmin) in group A was significantly higher than group B(P=0.021).CRP,PCT,IL-6,and TBIL were correlated with VCZ_(cmin)(P<0.05).CRP,PCT,IL-6,and TBIL had a significant impact on VCZ_(cmin)(P<0.05).VCZ_(cmin),PCT,and TBIL were independent risk factors for liver injury(P<0.05).The patients with VCZ_(cmin)≥3.76 mg/L had a significantly increased risk of liver injury.CONCLUSIONS VCZ_(cmin),PCT,and TBIL are independent risk factors for the occurrence of liver injury in elderly patients with hypoproteinemia.For patients with high PCT and TBIL,VCZ_(cmin) and liver function should be closely monitored during VCZ treatment to reduce the risk of liver injury.

关 键 词：伏立康唑 肝损伤 老年 低蛋白血症 谷浓度 炎症因子 独立危险因素 

分 类 号：R969.3[医药卫生—药理学] R978.5[医药卫生—药学]