伏立康唑血药浓度与慢性阻塞性肺疾病患者药品不良反应的关联性分析

Analysis of correlation between blood concentration of voriconazole and adverse drug reactions in patients with chronic obstructive pulmonary disease

目的探讨伏立康唑血药浓度与肺部感染的慢性阻塞性肺疾病(COPD)患者药品不良反应的关联性。方法选取2022年1月—2023年12月诸暨市中心医院接受伏立康唑药物治疗且进行血清药物浓度监测的144例COPD患者为研究对象,经高效液相色谱法检测伏立康唑谷浓度,根据检测结果分为高谷浓度组(27例)、中谷浓度组(71例)、低谷浓度组(46例),分析药品不良反应发生率和血药浓度的关系。结果144例COPD患者的治疗总效率为81.94%,低谷浓度组的临床反应率(69.57%)低于高、中谷浓度组(分别为81.48%和90.14%),差异有统计学意义(P<0.05);144例COPD患者的不良反应发生率为17.36%,包括14例药物性肝损害(6例谷丙转氨酶上升)和11例幻觉、多梦和谵妄。高、中、低谷浓度组药品不良反应发生率(分别为29.63%、16.90%、10.87%)比较,差异有统计学意义(P<0.05)。结论伏立康唑谷浓度在1.0~4.0μg·mL^(-1)的临床反应率高且药品不良反应发生率相对较低。监测伏立康唑血药浓度对指导临床用药具有十分重要的意义,是提高疗效、降低不良反应的关键。

Objective To explore the correlation between the blood concentration of voriconazole and risks of adverse drug reactions in chronic obstructive pulmonary disease(COPD)patients suffering from pulmonary infection.Methods A total of 144 COPD patients who received treatment with voriconazole from January 2022 to December 2023 were selected as the subjects and their trough concentration of voriconazole were detected by high performance liquid chromatography.Then these patients were divided into high trough concentration group(n=27),medium trough concentration group(n=71)and low trough concentration group(n=46).The relationship between incidence of adverse drug reactions and blood drug concentration were analyzed in all the 3 groups.Results The overall efficiency of voriconazole was 81.94%.The clinical response rate in the low trough concentration group(69.57%)was lower than that in the other 2 groups(81.48% and 90.14%,respectively),with a statistically significant difference(P<0.05).The incidence of adverse reactions was 17.36%,including 14 cases of drug-induced liver damage(6 cases of elevated alanine aminotransferase)and 11 cases of hallucinations,dreaminess and delirium.The incidence of adverse drug reactions was statistically significant among the 3 groups(29.63%,16.90%,and 10.87%,respectively)(P<0.05).Conclusion The trough concentration of fluconazole between 1.0 and 5.5μg·mL^(-1)shows high response rate and relatively low incidence of adverse drug reactions.Monitoring the blood concentration of voriconazole is significant for guiding clinical medication and plays an key role in improving efficacy and reducing adverse reactions.