环孢素A用于银屑病治疗的血药浓度监测追溯分析

目的:评价环孢素A(cyclosporine A,CsA)血药浓度监测对临床银屑病治疗的有效监护作用。方法:收集2018—2020年中国医学科学院皮肤病医院161例采用CsA治疗的银屑病住院患者的资料,对性别、年龄、剂量、联合用药等与CsA血药浓度的相关影响进行比较分析。结果:161例患者共监测CsA血药浓度288例次,平均1.79次/例,平均CsA血药浓度为(123.23±49.72)ng/ml。女性患者的平均CsA日剂量明显高于男性患者,差异有统计学意义(P=0.013);男女患者平均CsA血药浓度比较,差异无统计学意义(P>0.05)。不同年龄段患者CsA血药浓度的差异有极显著统计学意义(P<0.001),日剂量的差异也有统计学差异(P<0.05)。不同类型银屑病患者CsA血药浓度的差异无统计学意义(P>0.05)。联合应用大环内酯类抗菌药物、钙通道阻滞剂、中药丹参等会影响CsA的血药浓度。结论:年龄、联合用药和食物都可能对CsA的血药浓度产生影响。临床应加强血药浓度监测,通过监测结果制订个体化给药方案,提高临床用药的安全性和有效性。

Retrospective Analysis of Blood Concentration Monitoring of Cyclosporine A in the Treatment of Psoriasis

OBJECTIVE:To evaluate the significant effects of blood concentration monitoring of cyclosporine A(CsA)in the treatment of psoriasis.METHODS:Data of 161 patients with psoriasis treated with CsA were collected in the Hospital for Skin Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College from 2018 to2020.The effects of gender,age,dose,drug combination and blood concentration of CsA were compared and analyzed.RESULTS:The blood concentration of CsA was monitored for 288 case-times in 161 patients,with an average of 1.79 times/case.The average blood concentration of CsA was(123.23±49.72)ng/ml.The average daily dose of CsA in female patients was significantly higher than that in male patients,and the difference was statistically significant(P=0.013).There was no statistical significance in the average blood concentration of CsA between male and female patients(P>0.05).The difference of blood concentration of CsA in patients of different ages was extremely significant(P<0.001),and the difference in daily dose was also statistically significant(P<0.05).There was no significant difference in blood concentration of CsA in patients with different types of psoriasis(P>0.05).The blood concentration of CsA was influenced by drug combination of macrolides,calcium antagonist and salviae miltiorrhizae.CONCLUSIONS:Age,drug combination and food may affect the blood concentration of CsA.Clinically,it is necessary to strengthen the blood concentration monitoring,and formulate individualized drug administration program based on the monitoring results to improve the safety and effectiveness of clinical administration.