61例伏立康唑血药浓度结果分析

目的:对伏立康唑开展血药浓度监测(TDM)的结果进行分析,阐明TDM对伏立康唑合理用药的必要性。方法:本研究通过回顾性分析伏立康唑TDM的结果,从性别、年龄、剂量与浓度相关性,浓度分布情况以及质子泵抑制剂(PPIs)对伏立康唑血药浓度的影响等多方面进行分析探讨。结果:伏立康唑血药浓度个体差异较大,其中<1.0 μg·mL^-1有12例,1.0~2.0 μg·mL^-1有15例,2.0~5.5 μg·mL^-1有25例,>5.5 μg·mL^-1有9例;剂量与浓度无明显相关性(R²=0.172);老年组(>60岁)vs非老年组(<60岁)(P=0.19)、男性组vs.女性组(P=0.27)。当联用PPIs时,随着PPIs对CYP2C19抑制程度的增加,伏立康唑血药浓度呈上升趋势,但组间无统计学意义。结论:伏立康唑血药浓度个体差异大,大部分患者使用后浓度不在治疗窗范围内。开展伏立康唑TDM有利于提高临床效应和提高安全性。

Retrospective analysis of voriconazole plasma concentrations in 61 patients

OBJECTIVE To analyze results of therapeutic drug monitoring (TDM) on plasma concentrations of voriconazole in our hospital and clarify the necessity of TDM rational use of voriconazole. METHODS A TDM results on voriconazole were statistically tested by analyzing correlations between voriconazole plasma concentrations and multiple factors including sex,age and dose,distribution of concentrations,and influence of proton pump inhibitors (PPIs) on plasma concentrations. RESULTS Voriconazole plasma concentration showed great variation in patients,<1.0 μg·mL^-1 in 12 patients,1.0-2.0 μg·mL^-1 in 15 patients,2.0-5.5 μg·mL^-1 in 25 patients,and >5.5 μg·mL^-1 in 9 patients.Dose and concentration was not significantly correlated (R²=0.172).No significant difference was observed between old patients (>60) and other patients (<60) (P=0.19),or between male and female patients (P=0.27).Plasma concentration of voriconazole tended to increase with inhibiting potential of PPIs to CYP2C19,but no significant difference was observed between groups. CONCLUSION Voriconazole plasma concentration has great variation between individuals,and will not fall in therapeutic range after administration in most patients.Therefore,it is favorable for improving clinical efficacy and safety by performing TDM on voriconazole.