Relationship between plasma risperidone concentrations and clinical features in chronic schizophrenic patients in China

BACKGROUND Prior studies have noted great variability in the plasma levels of risperidone(RIS).Plasma concentrations of RIS and its active moiety are highly variable and depend on absorption,metabolism,and other predictors of metabolic dysregulation;however,these factors are poorly understood and the association between metabolic change and change in psychopathology is uncertain.AIM To ascertain the characteristics of chronic schizophrenic patients treated with RIS,and to assess their relationship with plasma RIS levels.METHODS This was a descriptive cross-sectional study of 50 patients with a diagnosis of schizophrenic psychosis treated with RIS in a psychiatric service.The plasma concentrations of RIS and its metabolite 9-hydroxyrisperidone were determined by high performance liquid chromatography.The patients’demographic and clinical characteristics,and psychopathologies were assessed,and the associations between clinical variables and plasma levels of RIS were explored.RESULTS Male patients received higher doses of RIS than female ones,but plasma concentrations of RIS and risperidone+9-hydroxyrisperidone(active moiety)were higher in female patients.Age and the mean scores of the general psychopathology subscale of the Positive and Negative Syndrome Scale(PANSS)were significantly positively correlated with plasma concentrations of risperidone+9-hydroxyrisperidone adjusted for weight and dose in all 50 subjects.In male subjects,we found a statistically significant positive correlation between the concentrations of risperidone+9-hydroxyrisperidone in plasma/(dose×kg)and age,mean PANSS negative subscale scores,mean PANSS general psychopathology subscale scores,and mean PANSS total scores.CONCLUSION Long-term use of RIS should be closely monitored in older patients and females to minimize the risk of high concentrations which could induce side effects.

The clinical value of enzyme-multiplied immunoassay technique monitoring the plasma concentrations of cyclosporine A after renal transplantation

The feasibility and the clinical value of the enzyme-multiplied immunoassay technique （EMIT） monitoring of blood concentrations of cyclosporine A （CsA） in patients treated with CsA were investigated after kidney transplantation. The validation method was performed to the EMIT determination of CsA blood concentration, the CsA whole blood trough concentrations （Co） of patients in different time periods after renal transplantation were monitored, and combined with the clinical complications, the statistical results were analyzed and compared. EMIT was precise, accurate and stable, also with a high quality control. The mean postoperative blood concentration of CsA was as follows： 〈1 month, （281.4± 57.9）ng/mL; 2 - 3 months, （264.5 ± 41.2） ng/mL; 4 - 5 months, （236.4 ± 38.9） ng/mL; 6 - 12 months, （206.5± 32.6）ng/mL; 〉12 months, （185.6± 28.1）ng/mL. The toxic reaction rate of CsA blood concentration within the recommended therapeutic concentration was 14.1%, significantly lower than that of the none-recommended dose group （37.2%） （P〈0.05）; the transplantation rejection rate was 4.4%, significantly lower than that of the none- recommended dose group （22.5%） （P〈0.05）. Using EMIT to monitor the blood concentration of CsA as the routine laboratory method is feasible, and is able to reduce the CsA toxicity and rejection significantly, leading to achieving the desired therapeutic effect.

Twenty-four-hour ambulatory blood pressure changes in older patients with essential hypertension receiving monotherapy or dual combination antihypertensive drug therapy

Objective To evaluate the differences in 24-hour ambulatory blood pressure (BP) in older patients with hypertension treated with the five major classes of antihypertensive drugs,as monotherapy or dual combination therapy,to improve daytime and nighttime BP control. Methods We enrolled 1920 Chinese community-dwelling outpatients aged ≥ 60 years and compared ambulatory BP values and ambulatory BP control (24-hour BP < 130/80 mmHg;daytime mean BP < 135/85 mmHg;and nighttime mean BP < 120/70 mmHg),as well as nighttime BP dip patterns for monotherapy and dual combination therapy groups. Results Patients’ mean age was 71 years,and 59.5% of patients were women. Calcium channel blockers (CCBs) constituted the most common (60.3% of patients) monotherapy,and renin–angiotensin system (RAS) blockers combined with CCBs was the most common (56.5% of patients) dual combination therapy. Monotherapy with beta-blockers (BB) provided the best daytime BP control. The probabilities of having a nighttime dip pattern and nighttime BP control were higher in patients receiving diuretics compared with CCBs (OR = 0.52,P = 0.05 and OR = 0.41,P = 0.007,respectively). Patients receiving RAS/diuretic combination therapy had a higher probability of having controlled nighttime BP compared with those receiving RAS/CCB (OR = 0.45,P = 0.004). Compared with RAS/diuretic therapy,BB/CCB therapy had a higher probability of achieving daytime BP control (OR = 1.27,P = 0.45). Conclusions Antihypertensive monotherapy and dual combination drug therapy provided different ambulatory BP control and nighttime BP dip patterns. BB-based regimens provided lower daytime BP,whereas diuretic-based therapies provided lower nighttime BP,compared with other antihypertensive regimens.

Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

Background. Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. Methods. We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. Results. Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. Conclusion. Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.

Effects of Chinese herbal medicine Yiqi Huaju Formula on hypertensive patients with metabolic syndrome:a randomized,placebo-controlled trial

BACKGROUND： Patients with hypertension coupled with metabolic syndrome （MetS） are among the high risk population in cardiovascular and cerebrovascular diseases. To reduce the prevalence of cardiovascular and cerebrovascular diseases, it is essential to appropriately control b^ood pressure together with other cardiovascular risk factors. OBJECTIVE： The current study was designed to investigate the therapeutic effects on blood pressure, blood pressure variability and other cardiovascular risk factors by giving Yiqi Huaju Formula, a compound traditional Chinese herbal medicine, in addition to routine treatment to hypertensive patients coupled with MetS. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： A total of 43 patients with hypertension coupled with MetS were recruited into this study. The enrolled patients were randomly divided into the Chinese herbal formula group （anti-hypertensive drugs plus Yiqi Huaju Formula, CHF） and the control group （anti-hypertensive drugs plus placebo）. The CHF group enrolled 22 patients while the control group received 21 cases. Treatments were given for 12 weeks in both groups. MAIN OUTCOME MEASURES： Parameters examined include 24-hour ambulatory blood pressure monitoring, body mass index, waist circumference, waist-to-hip ratio, homeostatic model assessment for insulin resistance （HOMA-IR）, fasting glycosylated hemoglobin （HbAlc）, fasting plasma glucose, 2-hour postprandial plasma glucose （PPG）, fasting plasma insulin, serum lipid, etc. RESULTS： Compared with the control group, the CHF group had significant improvement （P〈0.01） in anthropometric parameters, FPG, HOMA-IR, blood pressure amplitude, blood pressure variability and blood pressure load. CONCLUSION： This study showed that integrated traditional Chinese and Western medicine treatment can achieve better results in controlling blood pressure as well as other cardiovascular risk factors. The mechanism of controlling of blood pressure may be associated with the improvement of insulin sensitivity due to the Yiqi Huaju intervention. TRIAL REGISTRATION IDENTIFIER： ChiCTR-TRC-11001633.

Early effects of Lansoprazole orally disintegrating tablets on intragastric pH in CYP2C19 extensive metabolizers

AIM: To compare rabeprazole (RPZ; 10 mg) with Lansoprazole orally disintegrating tablets (LPZ; 30 mg OD) in terms of antisecretory activity and blood drug concentration after a single dose. METHODS: Eight H pylori-negative cytochrome P450 (CYP) 2C19 extensive metabolizers were assigned to receive a single oral dose of RPZ 10 mg or LPZ 30 mg OD. Twelve hour intragastric pH monitoring was perform- ed on the day of treatment. Blood samples were also collected after the administration of each drug. RESULTS: LPZ 30 mg OD induced a significantly earlier rise in blood drug concentration than RPZ 10 mg; consequently, LPZ 30 mg OD induced a significantly earlier rise in median pH in the third and fourth hours of the study. CONCLUSION: In H pylori-negative CYP2C19 extensive metabolizers, LPZ 30 mg OD induced a significantly faster inhibition of gastric acid secretion than RPZ 10 mg.

阿帕替尼血药浓度测定方法的建立及临床应用

目的 建立测定阿帕替尼血药浓度的方法并进行临床应用。方法 采用超高效液相色谱(UPLC)法进行血药浓度测定,色谱柱为ACQUITY UPLC BEH C18,流动相为乙腈-0.1%甲酸水溶液(梯度洗脱),流速为0.2 mL/min,柱温为40℃,进样量为5μL。收集26例服用阿帕替尼癌症患者的病例资料,检测其血药浓度,分析阿帕替尼血药浓度与患者年龄、给药剂量、不良反应及联合用药的相关性,并检测患者治疗前后血清肾损伤相关因子[胱抑素C(CysC)、肾损伤分子1(KIM-1)、白细胞介素18(IL-18)、肿瘤坏死因子α(TNF-α)]水平。结果 阿帕替尼检测质量浓度在500~2 000 ng/mL范围内线性关系良好,精密度试验RSD为3.7%,稳定性试验RSD为4.9%,平均加样回收率为96.0%(RSD为2.1%)。26例患者的阿帕替尼血药浓度最低为103 ng/mL,最高为1 932ng/mL。患者的血药浓度随年龄呈波动降低趋势。在0.125或0.25 g给药剂量下,服用阿帕替尼的患者体内血药浓度集中在1 000~2 000 ng/mL范围内。26例癌症患者中有13例发生不良反应,其中血药浓度500~<1 000 ng/mL者未见不良反应发生。20例患者同时联用了其他药物,其血药浓度高低不同。治疗后,患者的血清CysC、KIM-1、IL-18、TNF-α水平均显著高于治疗前(P<0.05)。结论 所建立的UPLC方法能快速检测阿帕替尼血药浓度。临床使用阿帕替尼时应综合考虑患者年龄和药物联用等情况,并注意防范阿帕替尼可能导致的急性肾损伤。

万古霉素在重症感染中的治疗药物监测现状及前景

万古霉素被誉为治疗革兰阳性菌感染的最后一道防线,也是推荐的一线用药。因其治疗窗窄,重症患者需监测药物浓度以指导临床安全用药。传统上基于万古霉素谷浓度的治疗药物监测已被临床广泛接受。2009年美国传染病学会(IDSA)指南建议,对于重症患者目标谷浓度为15~20 mg/L。近十余年国内外学者对于该治疗浓度的安全性及有效性评价不一。2020年更新指南提出,肾损伤风险最小、最准确且最佳的给药方法是通过曲线下面积(AUC)指导给药剂量和监测,提倡个体化目标AUC/最低抑菌浓度(MIC)比值为400~600 mg/(h·L)。由此可见目前就万古霉素临床监测指标存在争议。因此,本文就万古霉素治疗重症感染过程中进行治疗浓度监测的手段及策略进行综述,对指导临床合理用药具有重要意义,有助于临床医师制定个体化给药方案,最大程度减少或避免药物毒性。

左乙拉西坦治疗药物监测的研究进展

左乙拉西坦(LEV)是第二代广谱抗癫痫药物,具有起效快、半衰期短、疗效确切、耐受性好、药物相互作用少等优点。为提高LEV的临床效果,减少不良反应的发生,应对儿童、妊娠期妇女、老年人、肾功能不全等特殊人群予以治疗药物监测(TDM)。临床上LEV监测样本常选择血浆或血清,监测方法多选择免疫分析法或色谱分析法。LEV的有效浓度范围目前尚无统一意见,血药浓度与不良反应的相关性也不明确。影响LEV血药浓度的因素主要有年龄、妊娠及患者用药依从性等。如何解读TDM结果并根据结果调整给药剂量是今后工作的重点。

羟氯喹血药浓度影响因素的研究进展

羟氯喹最初被用作抗疟药,由于其成本效益、安全性和有效性,现已被广泛用于治疗风湿免疫病。除了免疫调节作用外,羟氯喹还表现出抗血栓、降脂和降糖的特性。羟氯喹血药浓度和临床治疗结果和不良反应相关,并且能反映患者依从性。但由于羟氯喹药动学特征复杂,即使服用相同剂量,血药浓度在个体间表现出很大的差异。该文从生理因素、病理因素、代谢酶基因多态性、药物因素等方面探讨影响羟氯喹血药浓度的因素,以期为临床合理用药、制定个体化给药方案提供参考。

万古霉素治疗药物监测的热点与进展

治疗药物监测是维持万古霉素疗效和预防不良反应的重要手段,并有助于制定个体化的给药剂量方案。随着中国和美国指南关于治疗药物监测指标的更新,以24 h药-时曲线下面积(AUC_(24 h))引导的治疗药物监测逐渐成为热点。与谷浓度引导的治疗药物监测相比,AUC_(24 h)引导的治疗药物监测能够降低万古霉素引起的急性肾损伤的发生率。临床上可以通过贝叶斯法和线性药代动力学方法来实施AUC_(24 h)引导的治疗药物监测,这2种方法均可以实现AUC_(24 h)的预测,达到早期干预的目的。各医疗机构有必要根据机构实际情况选择合适的监测方法。

Paxlovid对肺移植患者他克莫司血药浓度影响的研究

目的探索奈玛特韦片/利托那韦片组合包装(Paxlovid)对肺移植患者他克莫司(Tacrolimus,TAC)血药浓度的影响,为肺移植术后的新型冠状病毒感染患者服用Paxlovid与TAC时的用药安全提供合理参考。方法回顾性分析2022年11月1日至2023年1月31日中日友好医院收治的5例肺移植术后服用Paxlovid的患者(服用Paxlovid之前,5例患者的TAC血药浓度均已达稳态),测定服用Paxlovid期间及之后的TAC谷浓度,记录Paxlovid停药后重新启用TAC的时间和剂量,同时收集用药期间患者的肝肾功能指标数据。结果在Paxlovid使用期间,3例患者的TAC血药浓度分别下降19.4%、8.4%、14.7%,另外2例分别升高了21.6%、80.6%。重新启用TAC之后,3例患者TAC谷浓度出现了先上升(平均上升59.5%)后下降(平均下降33.3%)的趋势,而另外2例患者TAC谷浓度则一直持续下降。4例患者分别是在TAC血药浓度为基线水平的47.2%、72.6%、83.8%、60.3%时开始恢复使用TAC,1例则是在基线水平的171.2%开始启用TAC。2例患者以基线剂量开始启用TAC,另外3例患者分别以85.7%、44.4%、90.9%的基线剂量开始重新使用。结论Paxlovid会对TAC血药浓度产生影响,不仅是在Paxlovid治疗期间,甚至持续至停药后第6天,存在显著的个体差异,建议在患者治疗期间严密监测TAC血药浓度,根据血药浓度实行个体化TAC给药方案。

二维液相色谱检测脑胶质瘤患者同步放化疗及辅助化疗期间的血浆替莫唑胺峰浓度

目的 建立胶质瘤患者血浆替莫唑胺峰浓度的快速测定方法,并分析同步放化疗及辅助化疗期间其血药浓度分布的特点。方法 血浆以盐酸酸化后加冰乙腈去蛋白处理,离心分取上清。样本经Aston SNCB一维色谱柱(4.6 mm×50 mm,5 μm)在线萃取,在Aston SBR二维色谱柱(4.6 mm×250 mm,5 μm)色谱分离。一维流动相为 MVV-1C型样本萃取液,流速为0.8 mL·min^(-1);二维流动相由OPI-2A型、BPI-2C型、API-2C型、MPI-2A型样本萃取液组成,流速为1.2 mL·min^(-1);进样量200 μL,柱温40℃,检测波长330 nm。结果 血浆替莫唑胺在0.4~25.6 μg·mL^(-1)与峰面积线性关系良好(r=0.9995),转移回收率大于96.50%,提取回收率大于95.72%,日内、日间准确度和精密度良好。测定53例患者血浆样本,同步放化疗期间患者替莫唑胺剂量标准化平均峰浓度明显大于其辅助化疗期间(8.25 μg·mL^(-1) vs 5.82 μg·mL^(-1));同步放化疗期间男性剂量标准化平均峰浓度低于女性(5.86 μg·mL^(-1) vs 12.33 μg·mL^(-1))。结论 该方法简便、快速、准确,适合替莫唑胺血浆峰浓度监测。

同时测定血浆INH、AcINH、RFP和PZA的高效液相色谱法建立及其在肺结核患者中的应用

目的建立同时测定血浆异烟肼(INH)、乙酰异烟肼(Ac INH)、利福平(RFP)、吡嗪酰胺(PZA)的高效液相色谱法(HPLC),并验证其在肺结核患者中的应用效果。方法 HPLC色谱柱为Waters Xselect-HSS T3(250 mm×4.6 mm,5μm),以乙腈和磷酸二氢钾为流动相,柱温40℃,流速0.8~1.0 m L/min,进样体积20μL。同时进样含INH、Ac INH、RFP、PZA对照品的血浆,检验方法的专属性、线性关系、精密度和准确度、稳定性及回收率。取联合服用INH、乙胺丁醇、RFP和PZA的10例肺结核患者的血浆样本,采用上述HPLC测定INH、Ac INH、RFP和PZA的血药浓度。结果血浆样本中INH、Ac INH、RFP和PZA各组分有较好的分离,互不干扰;在线性范围内与峰面积线性关系良好(r2>0.99);日内、日间精密度均<10%;稳定性较好;回收率为80%~120%。肺结核患者中除1例Ac INH和1例RFP血药浓度低于线性范围外,其余数据均在线性范围内。结论成功建立了同时测定血浆INH、Ac INH、RFP、PZA的HPLC方法,该方法专属性好,样品处理简单,符合生物样品分析要求。

某院2022年丙戊酸钠血药浓度监测结果分析

目的分析某院丙戊酸钠(VPA)血药浓度监测结果及其影响因素,为临床合理用药提供参考。方法回顾性收集2022年1月~12月在常熟市第二人民医院行VPA血药浓度监测的241例患者资料,采用卡方检验或Fisher精确检验分析年龄、药物剂型及联合用药对VPA血药浓度的影响。结果241例患者共行438例次VPA治疗药物监测,血药浓度达标率为58.7%。监测多次的患者中,调整剂量后的监测结果达标率较调整前均有提高。单因素分析显示,剂型和联合用药是影响VPA血药浓度的相关因素(P<0.05)。结论临床使用丙戊酸钠时应注重血药浓度监测,并及时根据监测结果及临床症状调整给药剂量,以提高抗癫痫治疗效果,降低不良反应发生率。

复方磺胺甲噁唑血药峰浓度测定对治疗非人类免疫缺陷病毒感染患者耶氏肺孢子菌肺炎的临床意义

目的:探索监测复方磺胺甲噁唑(sulfamethoxazole complex, SMZco)中SMZ血药峰浓度对接受SMZco片治疗的非人类免疫缺陷病毒(immunodeficiency virus,HIV)感染患者耶氏肺孢子菌肺炎(Pneumocystis jirovecii pneumonia,PJP)疗效和安全性的指导意义。方法:采集2019年1月至2023年5月在瑞金医院住院治疗的非HIV PJP患者的临床数据,回顾性分析患者SMZ血药峰浓度与疗效和不良反应发生情况的关系。结果:共纳入47例患者,SMZ的血药峰浓度范围为87.49~334.31 mg/L,中位数(四分位间距)为168.62(79.72)mg/L,64%的患者血药峰浓度>150 mg/L。患者30 d全因死亡率为28%,治疗阳性反应率为66%。其中,SMZ血药峰浓度≤150 mg/L患者与>150 mg/L患者30 d全因死亡和治疗阳性反应率差异无统计学意义。29例(62%)患者发生不良反应。相比SMZ血药峰浓度≤150 mg/L的患者,>150 mg/L的患者血小板减少(40%比6%,P=0.025)和血红蛋白降低(37%比0,P=0.013)等不良反应发生率更高,且严重不良反应的发生率更高(43%比12%,P=0.026)。结论:SMZco片用于治疗非HIV PJP患者时,SMZ血药峰浓度≤150 mg/L的患者较>150 mg/L的患者可获得相当的疗效,且发生严重不良反应的风险更小,建议该类患者常规监测SMZ血药峰浓度。

基于基因检测和血药浓度监测技术优化肝移植术后他克莫司个体化给药方案

他克莫司是广泛应用于临床的钙调神经磷酸酶类抑制剂,被作为肝移植术后预防和治疗急性排斥反应的一线药物。然而,在临床应用中,他克莫司表现出治疗窗口窄、药动学个体差异大等特点,移植后早期低浓度的他克莫司可能会诱发排斥反应;而高浓度的他克莫司可能会导致肾毒性和/或神经毒性,因此对于他克莫司药动学的影响因素进行深入研究至关重要。本文通过检索中国知网(CNKI)、维普、万方以及PubMed数据库,综述了临床上对患者实行基因检测和血药浓度监测的必要性,得出根据基因多态性进行给药以及寻找替代药时曲线下面积的最佳采样点策略可能将有助于临床医生对他克莫司的最佳起始剂量进行预测,进而帮助调整维持方案,且有望减少不良反应的发生。

肾病综合征患者他克莫司血药浓度监测及MLP预测模型建立

目的考察肾病综合征(NS)患者使用他克莫司后的血药浓度监测情况,同时建立他克莫司血药浓度预测模型。方法收集厦门大学附属中山医院2020年1月1日至2023年8月31日166例NS患者使用他克莫司的血药浓度监测数据(共计509次),并对其疗效、药物不良反应(ADR)与血药浓度的相关性进行分析。利用其中109例含有基因信息的NS患者的302次血药浓度监测数据建立多层感知机(MLP)预测模型,并对其进行验证。结果在疗效方面,未缓解组患者的中位血药浓度为2.20 ng/mL,显著低于部分缓解组的4.00 ng/mL(P<0.001)和完全缓解组的3.60 ng/mL(P=0.002)。在ADR方面,发生ADR组患者的中位血药浓度为5.01 ng/mL,显著高于未发生ADR组的3.37 ng/mL(P=0.001),且经受试者工作特征曲线亚组分析后可知,他克莫司血药浓度≥6.65 ng/mL时,患者更易发生血肌酐升高[曲线下面积(AUC)为0.764,P<0.001];他克莫司血药浓度≥6.55 ng/mL时,患者更易发生血糖升高(AUC=0.615,P=0.005)。所建立的MLP预测模型的损失函数值为0.9,预测值与实测值的平均误差绝对值为0.2795ng/mL,验证散点图的决定系数为0.984,说明模型取得了良好的预测效果。结论他克莫司血药浓度对NS患者的疗效和ADR均有影响。利用MLP模型进行血药浓度预测的准确率高,预测值与实测值之间误差小,该模型可作为临床个体化用药方案中的重要工具。

实体器官移植受者侵袭性真菌病的临床治疗管理

随着实体器官移植(SOT)的广泛开展,SOT受者术后侵袭性真菌病(IFD)的发生率呈逐年上升趋势。近年来,对于SOT受者预防性抗真菌治疗意识不断增强,随之也出现了真菌耐药问题,导致原有标准化抗真菌治疗的效果不理想。而药物相互作用、药物的肝肾毒性等问题,也是临床医师需面对的挑战。本文综述了目前三唑类、棘白菌素类以及多烯类抗真菌药物与免疫抑制药之间的药物相互作用和肝肾毒性等特征,并总结了目前不同种类SOT受者术后IFD的预防策略以及感染不同病原体导致IFD的治疗策略,旨在为器官移植及相关学科的医师提供参考。

欧洲医药保健网分类系统在甲氨蝶呤个体化用药相关问题的应用

目的应用欧洲医药保健网(PCNE)分类系统对应用甲氨蝶呤(MTX)患者个体化用药中的药物相关问题(DRPs)进行分析探讨,为规范化个体化药学服务提供参考。方法以MTX用药后进行血药浓度测定和基因监测的患者为研究对象,采用PCNE分类系统(9.1版)分析MTX的DRPs,并对存在DRPs的问题、原因、介入干预以及接受程度进行分析。结果本研究共117例患者的738例次MTX的药学服务,发现244例次发生或潜在发生DRPs,85.25%进行了介入干预,介入干预接受208例次,接受率为73.56%。其中(可能)发生药品不良事件(n=188,77.05%)为DRPs常见问题,一个问题可能有多个原因,其中不适当的组合(27.08%)为主要原因。结论PCNE分类系统的引入有助于在MTX的个体化用药中实现药学服务的标准化,建立完善的精准药学服务体系,提升药学服务能力,促进合理用药。