恶性血液病患者比阿培南血药浓度影响因素分析

Influencing factors for blood concentration of biapenem in patients with malignant hematological diseases

目的:监测恶性血液病患者比阿培南血药浓度,为临床个体化用药提供建议。方法:回顾性收集南京鼓楼医院血液内科使用比阿培南的恶性血液病患者临床资料,使用高效液相色谱法检测比阿培南血药浓度,分析PK/PD达标率及影响血药浓度的相关因素。结果:老年组(≥65岁)患者血药浓度(P<0.01)和达标率(P=0.025)显著高于非老年组患者。恶性血液患者伴发中性粒细胞缺乏或肾功能亢进可导致比阿培南血药浓度降低,伴发中性粒细胞缺乏比阿培南血药浓度达标率为61.43%,伴发肾功能亢进患者比阿培南血药浓度达标率为56.14%。结论:年龄、伴发中性粒细胞缺乏和肾功能亢进是影响恶性血液病患者血药浓度的主要因素。对于中性粒细胞缺乏伴发热的恶性血液病患者,推荐实施治疗药物浓度监测并结合数学建模的方法,以实现特殊人群比阿培南的个体化精准用药。

OBJECTIVE To monitor the blood concentration of biapenem in patients with hematological malignancies and provide recommendations for clinical individualized medication.METHODS The clinical data of patients with malignant hematological diseases treated with biapenem in Department of Hematology of Nanjing Drum Tower Hospital were collected retrospectively. The blood drug concentration of biapenem was detected by high performance liquid chromatography, and the compliance rate of PK/PD and the related factors affecting the blood drug concentration were analyzed.RESULTS The blood concentration(P<0.01) and the success rate(P=0.025) of patients in the elderly group(≥65 years old) were significantly higher than those in the non-elderly group. The blood concentration of biapenem in patients with malignant blood associated with neutrophilic deficiency or renal hyperfunction was decreased. The rate of reaching the standard of blood concentration of biapenem in patients with accompanying neutrophilic deficiency was 61.43%, and the rate of reaching the standard of blood concentration of biapenem in patients with accompanying renal hyperfunction was 56.14%.CONCLUSION Age, accompanied by agranulocytosis and renal hyperfunction are the main factors that affect the blood drug concentration of patients with malignant hematological diseases. For patients with hematologic malignancies with neutropenia and fever, it is recommended that therapeutic drug concentration monitoring combined with mathematical modeling be performed to achieve individualized and precise dosing of biapenem in the special population.