儿童患者西罗莫司血药浓度监测及临床应用分析

Blood Concentration Monitoring and Clinical Application of Sirolimus in Children

目的:探讨西罗莫司在儿童患者中的血药浓度,考察血药浓度与相关实验室指标的关系,为西罗莫司的合理应用提供更多的临床依据。方法:选择54例使用西罗莫司治疗的患儿,记录基本信息、西罗莫司全血谷浓度(C_(SRL))、肝功能和中性粒细胞计数(NEU)等相关信息。结果:儿童患者西罗莫司血药浓度为(8.7±5.9)ng/mL,16.7%的患儿血药浓度<4.0 ng/mL,62.9%的患儿血药浓度为4.0~12.0 ng/mL,20.4%的患儿血药浓度>12.0 ng/mL。51.9%的患儿使用西罗莫司治疗结节性硬化症,与治疗其他疾病相比,治疗该疾病时其西罗莫司血药浓度最低,为4.6(3.9)ng/mL;在治疗结节性硬化症时,60.7%患儿都有联合使用抗癫痫药物的情况,其中以联合丙戊酸的比例最高(57.1%)。天冬氨酸氨基转移酶(AST)与C_(SRL)呈正相关(r=0.458,P<0.05)。在血药浓度>12.0 ng/mL的患儿中,AST、丙氨酸氨基转移酶(ALT)和NEU的结果异常率直线上升。结论:儿童患者在使用西罗莫司时,需要及时、定期进行血药浓度、血常规和肝功能等指标的监测,充分施行个体化用药,以保证临床疗效。

Objective:To probe into the blood concentration of sirolimus in children,and to investigate the correlation between blood concentration and related laboratory indicators,so as to provide more clinical evidence for the rational use of sirolimus.Methods:Fifty-four pediatric patients treated with sirolimus were enrolled,and the basic information,blood concentration of sirolimus(CSRL),liver function and neutrophil(NEU)and other related information were recorded.Results:The blood concentration of sirolimus in children was(8.7±5.9)ng/mL,16.7%of the children with blood concentration of<4.0 ng/mL,62.9%of the children with blood concentration from 4.0 to 12.0 ng/mL,and 20.4%of children with blood drug concentration>12.0 ng/mL.Sirolimus was used for tuberous sclerosis in 51.9%of children,with the lowest blood concentration of sirolimus 4.6(3.9)ng/mL when compared with other diseases.In the treatment of tuberous sclerosis,60.7%of children were treated with antiepileptic drugs in combination,of which the proportion of drug combination of valproic acid was the highest(57.1%).Aspartate aminotransferase(AST)was positively correlated with CSRL(r=0.458,P<0.05).In children with blood concentration>12.0 ng/mL,there was a linear increase in the rate of abnormal AST,alanine aminotransferase(ALT)and NEU.Conclusion:When sirolimus is used in children,it is even more important to monitor the blood concentration,blood routine and liver function on a timely and regular basis to fully implement the individualized dosing to ensure clinical efficacy.