肝功能不全患者伏立康唑血药谷浓度与CYP2C19基因型监测数据分析  

Data on Monitoring of CYP2C19 Phenotype and VoriconazolePlasma Concentrations in Patients with Liver Dysfunction

作　　者：李倩玉 杜春辉 王芳[1] 郑绯 赵庆国 LI Qian-yu;DU Chun-hui;WANG Fang;ZHENG Fei;ZHAO Qing-guo(Medical Supplies Center of PLA General Hospital,Beijing 100853,China;Chu Hsien-I Memorial Hospital,Tianjin Medical University,Tianjin 300134,China)

机构地区：[1]解放军总医院医疗保障中心,北京100853 [2]天津医科大学朱宪彝纪念医院,天津300134

出　　处：《解放军药学学报》2025年第1期38-42,共5页Pharmaceutical Journal of Chinese People's Liberation Army

基　　金：北京市科技计划课题,No.Z1611000000516175。

摘　　要：目的探讨肝功能不全患者使用伏立康唑后血药谷浓度的变化情况及其影响因素。方法收集2015年5月-2020年5月期间使用伏立康唑并接受血药浓度监测和CYP2C19基因型检测的肝功能不全患者的临床资料,分析不同程度的肝功能损伤患者中CYP2C19基因型与伏立康唑血药浓度的相关性,用多重线性回归分析法考察伏立康唑血药浓度的影响因素。结果99例患者共156份数据,其中Child-Pugh B级和C级不同CYP2C19基因型组间的稳态血药谷浓度(C_(min))及C_(min)达标情况差异均无统计学意义(P>0.05);给药持续时间(t=4.281,P<0.01)和总胆红素水平(t=3.383,P<0.01)可影响C_(min),回归方程为Y=3.287+0.120 X_(1)+0.004 X_(2)(r=0.402)。结论中重度肝功能不全患者CYP2C19基因多态性对伏立康唑C_(min)无显著影响,随着用药时间的延长,C_(min)呈升高趋势,因此有必要在给药期间持续行治疗药物监测,对蓄积血药浓度偏高的患者及时减量,预防不良反应的发生。Objective To explore the changes of voriconazole blood trough concentrations in patients with hepatic insufficiency and the influential factors.Methods The clinical data of patients who used voriconazole with their plasma concentrations monitored and CYP2C19 genotype tested between May 2015 and May 2020 was collected and analyzed.The influential factors of plasma concentrations of voriconazole were investigated with multiple linear regression analysis.Results A total of 156 pieces of data were collected from 99 patients.The differences in C_(min) and rates at which C_(min) met the standard between different CYP2C19 genotype groups of Child-Pugh class B and C were not statistically significant(P>0.05).The duration of drug administration(t=4.281,P<0.01)and levels of TBIL(t=3.383,P<0.01)could affect C_(min).The regression equation was Y=3.287+0.120 X_(1)+0.004 X_(2)(r=0.402).Conclusion CYP2C19 gene polymorphism has no significant effect on voriconazole C_(min) in patients with moderate to severe cirrhosis.C_(min) keeps increasing with the duration of medication.To prevent adverse reactions,constant therapeutic drug monitoring is needed during administration and the dosage has to be reduced in patients with high C_(min).

关 键 词：CYP2C19 肝功能不全 伏立康唑 血药浓度 治疗药物监测 

分 类 号：R969[医药卫生—药理学]