676例环孢素A血药浓度影响因素分析

The Influencing Factors on Blood Concentration of Cyclosporine A:Analysis of 676 Cases

目的:分析影响环孢素A(CsA)血药浓度的因素,为环孢素治疗药物监测和个体化用药提供参考。方法:收集并记录2013年01月—2015年12月我院676例检测环孢素A血药浓度的血液病患者的资料,包括性别、年龄、体重、临床诊断、环孢素药物(厂家剂型)、用法用量、合并用药、肝功能(ALT,AST)及饮食情况等,根据异常因素评价标准,分析各种因素对CsA血药浓度的影响。结果:性别、年龄、合并用药变化、饮食变化、服药依从性、肝功能、体重变化对CsA血药浓度均有显著的影响(P<0.05),而其中服药依从性是所有观察影响因素中差异显著性最大的(x^2=99.144;P<0.001)。结论:影响CsA血药浓度的因素众多,我们不能仅简单根据血药浓度结果更改用药方案,临床药师应该深入临床,开展血药浓度的解释、利用工作,帮助医师调整个体化用药剂量,保证患者用药安全、有效。

Objective： To analyze the factors influencing the blood concentration of cyclosporin A （CsA）, and provide reference for the therapeutic drug monitoring of CsA and individual drug use.Methods： Collect and record data of 676 cases of detection of cyclosporine A blood concentration in patients with haematological disease during January 2013 to December 2015, including sex, age, weight, clinical diagnosis, cyclosporine A （manufacturers and dosage）, usage and dosage, combined medication, liver function （ALT, AST） and diet, etc. According to the evaluation standard of abnormal factors, analyzed the influence of various factors on the blood con- centration of CsA. Results： Sex, age, changes of combined medication, changes in diet, medication compliance, liver function and weight change had significant effect on the blood concentration of CsA（P〈0.05）, while medication compliance is the biggest influencing factors in all observed factors（x2=99.144; P〈0.001）. Conclusion： There are many factors that influence the blood concentration of CSA, so we eann＇ t simply change medication just according to the blood drug concentration results. Clinical pharmacists should to go to the clinic and carry out the explanation and use work in TDM, in order to help physicians to adjust the individual dosage, and ensure the patient medication safety and effective.