64例儿童患者伏立康唑血药浓度监测数据回顾性分析

目的:探讨影响儿童患者伏立康唑血药浓度及引起不良反应的相关因素。方法:回顾性分析我院2017 年8 月至2022 年12 月接受伏立康唑治疗并实施血药浓度监测的儿童患者病例资料。结果:共纳入64 例患儿,送检样品89 个,伏立康唑血药浓度2. 90(1. 64~5. 22)mg/ L,达标率64. 04%。伏立康唑给药剂量与谷浓度呈正相关(r =0. 417,P<0. 05)。不同给药途径及是否联合奥美拉唑、环孢素治疗的患儿伏立康唑血药浓度比较差异有统计学意义(P<0. 05)。伏立康唑主要不良反应为电解质紊乱和肝损伤,高谷浓度是伏立康唑发生肝损伤的独立危险因素。肝损伤的受试者工作特征(ROC)曲线下面积为0. 674,临界值为1. 92 mg/ L(敏感度87. 1%,特异度50. 0%)。结论:儿童患者伏立康唑用药过程中影响其血药浓度因素众多,应基于血药浓度监测指导个体化用药,以确保儿童用药的有效性和安全性。

Retrospective Analysis of Voriconazole Concentration Monitoring in 64 Children

Objective: To probe into the factors affecting the blood concentration of voriconazole and adverse drug reactions in children.Methods: Case data of children receiving voriconazole treatment and blood concentration monitoring in our hospital from Aug. 2017 toDec. 2022 were retrospectively analyzed. Results: A total of 64 children were included, the blood concentration of voriconazole in 89samples was 2. 90 (from 1. 64 to 5. 22) mg/ L, 64. 04% of the drug levels were within therapeutic range. The administration dosage of voriconazole was positively related with trough concentration (r = 0. 417, P<0. 05). Different routes of administration and whether tocombined with omeprazole, cyclosporine had significant difference on the blood concentration of voriconazole (P <0. 05). The mainreported adverse drug reactions were electrolyte disturbance and hepatotoxicity. High trough concentration was the independent riskfactors associated with hepatotoxicity of voriconazole. The area under the receiver operating characteristic (ROC) curve was 0. 674 forhypohepatia. The cut-off values of voriconazole concentration was 1. 92 mg/ L for hepatotoxicity (with sensitivity of 87. 1%, specificity of50. 0%). Conclusion: The blood concentration of voriconazole in children could be affected by many factors, the therapeutic drugmonitoring is helpful to guide individualized therapy and ensure the safety and efficacy of voricaonazole in children.