肾移植科伏立康唑血药浓度监测结果分析

Monitoring data analysis of voriconazole blood concentration in the Department of Kidney Transplantation

目的:分析肾移植患者伏立康唑血药浓度监测结果,为伏立康唑的临床合理应用提供参考。方法:采用回顾性研究方法,对某院肾移植科使用伏立康唑治疗并测定浓度的住院患者进行信息归纳,从浓度分布情况,质子泵抑制剂(PPIs)、钙调磷酸酶抑制剂(CNI)、给药途径及产地对伏立康唑血药浓度的影响等方面进行分析探讨。结果:肾移植科伏立康唑谷浓度在2～4μg·mL-1范围内仅占33.9%;联用PPIs可显著增加伏立康唑谷浓度(U=4578.5, Z=–3.096, P=0.002);联用他克莫司和环孢素可以显著降低伏立康唑日剂量(U=5420, Z=–1.618, P=0.106;U=754.5, Z=–2.905, P=0.004);口服组伏立康唑血药浓度中位数低于静脉组,但组间差异无显著性(U=6474.5, Z=–1.553, P=0.120);给药途径为静脉给药者,进口组的血药浓度显著高于国产组(P=0.005);给药途径为口服者,进口组和国产组差异无显著性(P=0.949)。结论:伏立康唑血药浓度个体差异大,受药物相互作用影响大,个体化治疗时需要进行血药浓度监测。

OBJECTIVE To provide a basis for the rational use of voriconazole in the Kidney transplant patients through the analysis on the therapeutic monitoring data. METHODS Retrospective analysis method was used to generalize information on inpatients treated with voriconazole and measured concentrations in the department of kidney transplantation. Distribution of concentrations, and influence of proton pump inhibitors(PPIs), calcineurin inhibitors(CNIs),route of drug administration and place of production on blood concentrations were analyzed. RESULTS The concentration of voriconazole in the kidney transplant department was only 33.9% in the range of 2–4 μg·mL^-1. The voriconazole concentration was significantly increased by combined use of PPIs(U=4 578.5, Z=-3.096, P=0.002). The daily dose of voriconazole was significantly reduced by combined use of tacrolimus and cyclosporine(U=5 420, Z=–1.618, P=0.106;U=754.5, Z=–2.905, P=0.004). The median blood concentration of voriconazole in the oral group was lower than that in the intravenous group, but the difference between the groups was not statistically significant(U=6 474.5, Z=–1.553, P=0.120).For intravenous administration, the blood concentration of the imported group was significantly higher than that of the domestic group(P=0.005). For oral administration, the difference between the imported group and the domestic group was not statistically significant(P=0.949). CONCLUSION Voriconazole blood concentration shows great variation in patients,and is affected by drug interactions. Monitoring of blood concentration is useful to the individualized treatment.