基于真实世界数据对老年患者伏立康唑常见不良反应的危险因素研究

Study on risk factors for common voriconazole-induced adverse reactions in elderly patients based on a real-world data

目的分析老年患者伏立康唑常见不良反应及其相关危险因素。方法对温州市中心医院2017年8月至2022年8月接受伏立康唑治疗并实施血药浓度监测老年患者的病例资料进行回顾性分析。结果共收集90例患者,31例(34.44%)患者出现肝损伤,15例(16.67%)患者出现电解质紊乱,9例(10.00%)患者出现精神症状。单因素分析结果表明,高谷浓度是伏立康唑发生肝损伤和精神症状的独立危险因素。肝损伤和精神症状的受试者工作曲线下面积分别为0.674和0.86,临界值分别为1.92 mg·L^(-1)(敏感度87.1%,特异度50.0%)和4.02 mg·L^(-1)(敏感度88.9%,特异度76.7%)。结论伏立康唑高谷浓度与不良反应密切相关,基于血药浓度监测引导个体化给药,能够有效降低不良反应的发生率。

Objective To analyze the risk factors for common voriconazole-induced adverse reactions in elderly patients.Methods A retrospective cohort study was conducted to collect the clinical data of the elderly patients who were treated with voriconazole and monitored for blood concentrations in Wenzhou Central Hospital from August 2017 to August 2022.Results A total of 90 patients were included,of whom 31(34.44%)had liver damage,15(16.67%)had electrolyte disturbance,and 9(10.00%)had mental disorders.Univariate analysis showed that high trough concentration was the independent risk factor for liver damage and mental disorders of the patients with voriconazole-induced adverse reactions.The area under receiver operating characteristic(ROC)curve was 0.674 for the patients with liver damage,0.86 for the patients with mental disorders;respectively.The cut-off value of the drug concentration was 1.92 mg·L^(-1) for the patients with liver damage(sensitivity 87.1%,specificity 50.0%),and 4.02 mg·L^(-1) for the patients with mental disorders(sensitivity 88.9%,specificity 76.7%).Conclusion The minimum concentration of voriconazole is closely associated with the adverse reactions.Individualized medication based on the monitoring of blood concentration can effectively reduce the incidence of voriconazole-induced adverse reactions.