妊娠期药动学变化与生理药动学模型在妊娠期药动学研究中的应用

Changes of pharmacokinetics and application of physiologically based pharmacokinetic modeling in pharmacotherapy during pregnancy

妊娠妇女合理用药是医生和药师必须认真对待的临床问题。妊娠期间体内大多数组织器官都会发生解剖和生理学的改变,从而影响药物的吸收、分布、代谢和排泄等体内过程,最终导致生物利用度的变化。因此为达到有效治疗浓度,孕期可能需要剂量调整。过去的十几年中建模与仿真技术在新药研发和临床治疗领域的应用不断扩展,例如用群体药动学(population pharmacokinetics, PPK)和生理药动学(physiologically based pharmacokinetics,PBPK)建模方法来设计特殊人群的给药方案。严谨设计和验证的模型能有效弥补临床试验的不足,为临床研究方案设计提供极有价值的参考,甚至替代部分临床试验。本文将介绍妊娠期影响药物药动学性质的生理学变化,并综述PBPK模型在妊娠期药动学研究中的应用进展。

The rational medication in pregnant women is a clinical issue that clinicians and pharmacists must take seriously. Most tissues and organs undergo anatomical and physiological changes during pregnancy that affect the absorption, distribution, metabolism, and excretion of drugs in vivo, which ultimately lead to changes in bioavailability. In order to achieve an effective therapeutic concentration, dose adjustment might be required during this period. In the past ten years, the application of modeling and simulation methods in the field of drug development and clinical therapy has continued to expand, for instance, using population pharmacokinetic(PPK)and physiologically based pharmacokinetic(PBPK) modeling to adjust dosage regimen in special populations.Rigorously designed and validated models will effectively make up for the deficiencies of clinical trials, provide valuable references for the design of clinical research, and even replace part of them. This article will introduce the physiological changes that affect the pharmacokinetic properties of the drug during pregnancy and review the progress in the application of PBPK modeling in pharmacokinetic studies in pregnant women.