伏立康唑群体药物代谢动力学研究进展

Research Progress of Population Pharmacokinetics of Voriconazole

目的为伏立康唑的个体化给药提供参考。方法通过中国期刊全文数据库、万方数据库、中国生物医学文献服务系统、Pub Med及Web of Science等数据库检索自建库起至2020年3月国内外公开发表的伏立康唑群体药物代谢动力学(简称药动学)研究文献,分析伏立康唑药动学的影响因素。结果最终纳入14篇文献,涉及侵袭性真菌感染、移植和免疫缺陷、肝功能不全和肝硬化三类疾病患者,伏立康唑群体药动学的影响因素中,患者因素须纳入P450酶的CYP2C19基因型、综合的肝功能指标、年龄、体质量等协变量;移植和免疫缺陷患者还需考虑移植术后时间及是否联用吗替麦考酚酯。结论CYP2C19基因型、年龄、体质量、肝功能分级等均为影响伏立康唑药动学的因素,给药时应充分考虑,做到个体化给药,以利于伏立康唑从体内顺利清除。

Objective To provide a reference for the individualized administration of voriconazole.Methods The literature on population pharmacokinetics of voriconazole published at home and abroad were searched through the databases such as CJFD,WanFang database,SinoMed,PubMed and Web of Science from the inception to March 2020,and the factors affecting the pharmacokinetics of voriconazole were analyzed.Results A total of 14 studies were included,including patients with invasive fungal infection,patients with transplantation and immune deficiency,patients with liver dysfunction and liver cirrhosis.Among the influencing factors of population pharmacokinetics of voriconazole,patient-related factors must include covariates such as CYP2 C19 genotype of P450 enzyme,comprehensive liver function indexes,age and body weight.Patients with transplantation and immune deficiency should consider the postoperative duration and whether to use mycophenolate mofetil in combination.Conclusion CYP2 C19 genotype,age,body weight and liver function grade are all factors affecting the pharmacokinetics of voriconazole,which should be fully considered during individualized administration in order to facilitate the smooth clearance of voriconazole from the body.