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成人患者体内伏立康唑代谢的影响因素分析
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| 篇名： | 成人患者体内伏立康唑代谢的影响因素分析 |
| TITLE： | Analysis of influencing factors for the metabolism of voriconazole in adult patients |
| 摘要： | 目的 分析影响成人患者体内伏立康唑代谢的因素，为伏立康唑的临床合理应用提供参考。方法回顾性分析2021年4月－2022年3月我院使用伏立康唑并进行治疗药物监测的103例成人患者资料，同时测定血浆伏立康唑谷浓度（c0）、伏立康唑氮氧化物浓度（cN），并计算c0/cN值；采用Pearson’s相关性分析影响伏立康唑c0、c0/cN值的因素；采用多元线性回归模型分析伏立康唑c0、c0/cN值的独立影响因素。结果患者基础疾病以肺炎、肾脏疾病和白血病为主；感染真菌中以曲霉菌、念珠菌和酵母样真菌为主；给药方式主要为静脉滴注，以联用质子泵抑制剂患者最多。C反应蛋白（CRP）、总胆红素（TBIL）、直接胆红素（DBIL）、间接胆红素（IBIL）水平与伏立康唑c0均呈正相关，血小板计数和白蛋白水平与伏立康唑c0均呈负相关；CRP、TBIL、DBIL水平与c0/cN值均呈正相关，白蛋白水平与c0/cN值呈负相关。多元线性回归模型分析结果显示，伏立康唑c0的独立影响因素有CRP、IBIL、伏立康唑给药方式和给药剂量，伏立康唑c0/cN的独立影响因素有CRP、DBIL和年龄。结论CRP、IBIL、伏立康唑给药方式和给药剂量是影响伏立康唑c0的独立因素，CRP、DBIL和年龄是影响c0/cN值的独立因素；临床使用伏立康唑时，应考虑上述指标对伏立康唑代谢的影响，合理调整伏立康唑的给药方式和剂量。 |
| ABSTRACT： | OBJECTIVE To analyze the influencing factors for the metabolism of voriconazole in adult patients， and to provide reference for the rational use of voriconazole in clinic. METHODS The clinical data of adult patients admitted in our hospital receiving voriconazole and therapeutic drug monitoring from April 2021 to March 2022 were collected. The trough concentration of voriconazole （c0） and plasma concentration of voriconazole-N-oxide concentration （cN） were determined， and voriconazole-to-voriconazole N-oxide concentration ratio （c0/cN） was calculated. Pearson’s correlation analysis was used to analyze the influencing factors for c0 and c0/cN of voriconazole. Multiple linear regression models were used to analyze the independent influencing factors for c0 and c0/cN of voriconazole. RESULTS The underlying diseases of the patients were mainly pneumonia， kidney disease and leukemia. The detected fungi were mainly Aspergillus， Candida and yeast-like fungi. Voriconazole was mainly administered by intravenous drip， especially in patients who used proton pump inhibitor in combination. The levels of C-reactive protein （CRP）， total bilirubin （TBIL）， direct bilirubin （DBIL） and indirect bilirubin （IBIL） were positively correlated with c0 of voriconazole， while platelet count and albumin levels were negatively correlated with voriconazole c0. The levels of CRP， TBIL and DBIL were positively correlated with c0/cN， while albumin levels were negatively correlated with c0/cN. Multiple linear regression analysis showed that the independent influencing factors of voriconazole c0 included the levels of CRP and IBIL， route of administration and dose of voriconazole， and the independent influencing factors of voriconazole c0/cN were the levels of CRP and DBIL and age. CONCLUSIONS The levels of CRP and IBIL， route of administration and dose of voriconazole are independent influencing factors of voriconazole c0； the levels of CRP and DBIL and age are independent influencing factors of voriconazole c0/cN. The influence of above indexes on the metabolism of voriconazole should be considered when using voriconazole clinically； and the route of administration and dose of voriconazole should be adjusted reasonably. |
| 期刊： | 2023年第34卷第04期 |
| 作者： | 程林；梁再明；喻明洁；孙凤军；戴青 |
| AUTHORS： | CHENG Lin，LIANG Zaiming，YU Mingjie，SUN Fengjun，DAI Qing |
| 关键字： | 伏立康唑；伏立康唑氮氧化物；治疗药物监测；谷浓度；影响因素；相关性 |
| KEYWORDS： | voriconazole； voriconazole-N-oxide； therapeutic drug monitoring； trough concentration； influencing factor； |
| 阅读数： | 211 次 |
| 本月下载数： | 7 次 |
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