恶性血液病儿童患者泊沙康唑稳态谷浓度监测及其影响因素分析

Monitoring of posaconazole steady-state trough concentration in pediatric patients with malignant hematologic diseases and influencing factors analysis

目的:分析恶性血液病儿童患者中泊沙康唑血浆谷浓度(trough concentration,Cmin)数据,并探讨影响Cmin的因素,为泊沙康唑个体化用药提供参考。方法:回顾性收集广州市第一人民医院2021年3月至2023年1月开展泊沙康唑治疗药物监测的恶性血液病儿童患者临床资料,分析年龄、性别、体质量、腹泻、合并用药等因素对泊沙康唑C_(min)的影响。结果:共纳入符合标准的儿童患者39例,收集130例次C_(min)监测数据,其中70例次的泊沙康唑C_(min)>0.7 mg·L^(-1),达标率为53.8%。患者体质量、给药剂量、合用质子泵抑制剂、特殊病理状态(腹泻、呕吐和肝功能)与泊沙康唑C_(min)显著相关。结论:影响恶性血液病儿童患者泊沙康唑C_(min)的因素较多,需密切进行治疗药物监测,且需根据体质量、合并质子泵抑制剂及特殊病理状态调整泊沙康唑给药方案,以确保应用泊沙康唑的有效性和安全性。

OBJECTIVE To provide recommendations for the individualized dosage of posaconazole,the data of posaconazole plasma trough concentration(C_(min))in children with malignant hematologic disorders were evaluated,and the factors impacting the Cmin were discussed.METHODS From March 2021 to January 2023,clinical data of children with hematologic malignancies were collected,and the effects of age,sex,weight,diarrhea,and combined medication on the C_(min) of posaconazole were analyzed.RESULTS A total of 39 pediatric patients who met the criteria were enrolled,and 130 C_(min) monitoring data were collected,of which 70 cases had posaconazole C_(min)>0.7 mg·L^(-1),and the compliance rate was 53.8%.Posaconazole C_(min) was significantly correlated with patient weight,administered dose,combined proton pump inhibitors,and specific pathological status(vomiting,diarrhea,and liver function).CONCLUSION There are many factors affecting posaconazole C_(min) in children with hematologic malignancies,so close therapeutic drug monitoring should be conducted,and posaconazole dosing regimen should be adjusted according to body weight,combined proton pump inhibitors and special pathological status to ensure the effectiveness and safety of posaconazole.