造血干细胞移植患者伏立康唑稳态谷浓度监测及其影响因素分析

Analysis of influence factors of voriconazole trough concentration in patients with hematopoietic stem cell transplantation

目的:研究伏立康唑在造血干细胞移植患者中的稳态谷浓度(Cmin)分布特征,探讨影响其稳态Cmin的因素。方法:回顾性分析72例使用伏立康唑的患者,测定226份血清标本中伏立康唑稳态Cmin,收集患者的临床资料。采用SPSS22.0软件分析伏立康唑稳态Cmin与协变量(性别,年龄,体质量,中性粒细胞计数,C反应蛋白,白蛋白,肝肾功能,药物相互作用等)的相关性。结果:伏立康唑Cmin的平均值是(1.84±0.09)μg/mL,在有效血药浓度范围内占84.5%。年龄、白蛋白、总胆红素和C反应蛋白对伏立康唑血药浓度有显著性影响。联用激素并未降低患者的伏立康唑Cmin。伏立康唑用药前后谷草转氨酶、谷丙转氨酶、直接胆红素有显著性差异。结论:影响伏立康唑血药浓度因素较多,应加强血药浓度监测,提高治疗的有效性,减少药物毒副反应。

AIM:To study the distribution characteristics of steady-state trough concentration(C min)of voriconazole in Chinese patients with hematopoietic stem cell transplantation,and to explore the factors that affect its steady-state C min.METHODS:A retrospective analysis of 72 patients using voriconazole,the steady-state C min of voriconazole in 226 serum samples were determined,and clinical data of the patients were collected.SPSS 22.0 software was used to analyze the correlation between voriconazole steady-state C min and covariates(gender,age,weight,white blood cell count,neutrophil count,C-reactive protein,albumin,liver and kidney function,drug interactions,etc.).RESULTS:The average C min of voriconazole was(1.84±0.09)μg/mL,which accounted for 84.5%of the effective blood concentration range.Age,albumin,total bilirubin,and CRP had a significant effect on the blood concentration of voriconazole.Combined use of hormones did not reduce the patient's voriconazole C min.It was found that there were significant differences in aminotransferase,alanine aminotransferase and direct bilirubin before and after voriconazole administration.CONCLUSION:There are many factors that affect the blood concentration of voriconazole.Blood concentration monitoring should be enhanced to improve the effectiveness of voriconazole treatment and reduce side effects of drugs.