男性慢阻肺合并肾功能损害患者多索茶碱血药浓度影响因素分析

Analysis of Influencing Factors of Doxofylline Blood Concentration in Male Patients with COPD and Renal Impairment

目的分析男性慢性阻塞性肺疾病合并肾功能损害患者多索茶碱血药浓度监测结果,探讨多索茶碱血药浓度影响因素。方法采用回顾性分析,收集2018年7月—2021年7月郑州市第二人民医院使用多索茶碱治疗的慢性阻塞性肺疾病合并肾功能损害的男性患者病例121例,记录血药浓度监测结果和患者人口学数据、检查指标、合并用药情况等资料。进行单因素分析,初步探讨可能的影响因素和血药浓度的关联性,并将因素纳入构建多因素线性回归模型,用以矫正混杂因素的影响。结果单因素结果显示多索茶碱血药浓度与患者年龄(r=0.32,P<0.001),体质量(r=–0.40,P<0.001),肾小球滤过率(r=–0.24,P=0.008)的关联性存在统计学意义。相对于重度肾功能损伤的患者,轻度损伤的患者多索茶碱血药浓度更低(P=0.017),吸烟患者的多索茶碱血药浓度更低(P=0.018)。在矫正了其他因素后,结果显示年龄越大,血药浓度越高(b=0.08,P=0.032),体质量越大,血药浓度越低(b=–0.14,P<0.001),吸烟患者的血药浓度相较于不吸烟的患者更低(b=–1.30,P=0.048)。结论对于合并肾功能损害的男性慢性阻塞性肺疾病患者,多索茶碱血药浓度与多种因素相关,年龄更大、体质量更小、肾小球滤过率更低的患者的血药浓度更高,吸烟可能导致多索茶碱血药浓度降低。

OBJECTIVE To analyze the monitoring results of doxofylline blood concentration in male patients with chronic obstructive pulmonary disease and renal impairment,and explore the influencing factors of doxofylline blood concentration.METHODS A retrospective analysis was used to collect 121 male patients with chronic obstructive pulmonary disease and renal impairment in Zhengzhou Second Hospital from July 2018 to July 2021,recorded the blood concentration monitoring results,patient demographic data,examination indicators and combined medication.Univariate analysis was performed to initially explore the association of possible influencing factors and the concentration of blood drugs.Factors were included to construct a multivariate linear regression model to correct for the effects of confounders.RESULTS Univariate results showed that the blood concentration of doxofylline was correlated with age(r=0.32,P<0.001),body weight(r=–0.40,P<0.001),and glomerular filtration rate(r=–0.24,P=0.008),the association was statistically significant.Compared with patients with severe renal impairment,patients with mild impairment had lower doxofylline plasma concentrations(P=0.017),and smoking patients had lower doxofylline plasma concentrations(P=0.018).After adjusting for other factors,the results showed that the older the age,the higher the blood drug concentration(b=0.08,P=0.032 the smoking patients),the heavier the weight,the lower the blood drug concentration(b=–0.14,P<0.001),and blood levels of the smoking patients were lower than those of non-smokers(b=–1.30,P=0.048).CONCLUSION For male patients with chronic obstructive pulmonary disease with renal impairment,the plasma concentration of doxofylline is related to various factors.Older,lighter,and lower GFR patients has higher plasma concentrations,and smoking may lead to lower doxofylline plasma concentrations.