伏立康唑致精神障碍的临床特征和危险因素分析

目的 探讨伏立康唑引起精神障碍的临床特征和危险因素.方法 回顾性分析使用伏立康唑而导致精神障碍24 例患者临床资料,并随机收集同期使用伏立康唑未引起精神障碍96 例患者为对照组,采用单因素分析（t检验,χ2检验）及多因素非条件Logistic 回归模型分析导致精神障碍的危险因素.结果 24 例精神障碍患者临床表现以意识障碍（谵妄状态）的发生率最高（50.0% ）,次之为感知觉障碍（幻视、幻听）,占25.0%.精神障碍发生于用药后（3±2）d,停药（2±1）d症状消失.单因素分析表明,年龄、用药阶段、每日单位体重维持剂量、应用质子泵抑制剂、血清ALT 水平与出现精神障碍有关,但经多因素Logistic 回归分析发现年龄（OR=1.136;95% CI=1.044~1.238;P=0.003 ）及每日单位体重维持剂量（OR=1.546;95% CI=1.062~2.251;P=0.023 ）为发生精神障碍的独立危险因素.结论 在应用伏立康唑的患者中,年龄及每日单位体重维持剂量是导致精神障碍的独立危险因素.

Objective To investigate the clinical features and risk factors of voriconazole-induced mental disorders. Methods Clinical data of 24 patients with mental disorders induced by voriconazole were analyzed from January, 2007 to February, 2012 in respiratory department of Nanfang Hospital. 96 cases without voriconazole-induced mental disorders who received voriconazole were randomized as control. T test, chi-square test and Logistic regression analysis were used for statistics. Results Delirium was the most common psychotic manifestation ofvoriconazole-induced mental disorders （ 50% ） , followed by the visual hallucinations and/or auditory hallucinations （ 25% ） . The mental symptoms occurred in 3 ＋ 2 days after receiving voriconazole and disappeared within 2 ＋ 1 days after drug withdrawal. Univariate analysis and multivariate Logistic regression analysis eventually revealed that the risk factors for voriconazole-induced mental disorders were age （ OR=1. 136; 95% CI=1.044-1.238; P=0.003 ） and daily maintenance dose per kilogram body weight （ OR=1.546; 95% CI=1.062-2.251; P=0.023 ） . Conclusion Age and daily maintenance dose per kilogram body weight are independent risk factors for mental disorders induced by voriconazole.