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肾移植患者伏立康唑血药谷浓度和不良反应的影响因素分析
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| 篇名： | 肾移植患者伏立康唑血药谷浓度和不良反应的影响因素分析 |
| TITLE： | Analysis of factors influencing the trough concentration of voriconazole and adverse drug reactions in renal transplant patients |
| 摘要： | 目的 分析肾移植患者伏立康唑血药谷浓度和不良反应的影响因素。方法回顾性分析2022年1月－2023年8月我院使用伏立康唑并进行血药浓度监测的住院患者资料，按是否接受肾移植分为肾移植组和非肾移植组。采用倾向性评分匹配（PSM）法以1∶1比例均衡两组的基线差异。比较两组患者的伏立康唑血药谷浓度及达标率、临床疗效及不良反应发生情况。采用多重线性回归模型（后退法）分析肾移植组患者伏立康唑血药谷浓度的影响因素；采用单因素分析和二元Logistic回归分析确定影响肾移植患者发生不良反应的独立危险因素。结果PSM后，两组各纳入48例患者。两组患者的伏立康唑平均血药谷浓度、达标率、有效率比较，差异均无统计学意义（P＞0.05）；肾移植组患者的不良反应总发生率显著高于非肾移植组（P＜0.05）。多重线性回归模型分析结果显示，年龄、平均日剂量、肺部感染、用药期间总胆红素、首日负荷剂量、使用原研药、合用免疫抑制剂和发生不良反应是影响肾移植患者伏立康唑血药谷浓度的因素（P＜0.05）。二元Logistic回归分析结果显示，用药期间直接胆红素异常[比值比＝7.747，95%置信区间（1.334，45.005），P＝0.023]是肾移植患者使用伏立康唑后发生不良反应的独立危险因素。结论年龄、平均日剂量、肺部感染、使用原研药、首日负荷剂量、用药期间总胆红素、合用免疫抑制剂和发生不良反应是影响肾移植患者伏立康唑血药谷浓度的因素，用药期间直接胆红素异常者较易发生不良反应。 |
| ABSTRACT： | OBJECTIVE To analyze the influencing factors of voriconazole trough concentration and adverse drug reactions （ADR） in renal transplant recipients. METHODS Data from inpatients who received voriconazole and therapeutic drug monitoring in our hospital between January 2022 and August 2023 were retrospectively analyzed. Patients were divided into renal transplant group and non-renal transplant group based on transplantation status. A 1∶1 propensity score matching （PSM） method was used to balance differences in baselines between the two groups. Voriconazole trough concentrations， target attainment rate， clinical efficacy， and ADR were compared between the two groups. Multiple linear regression （backward） was used to analyze the factors influencing voriconazole trough concentrations in the renal transplant group. Univariate analysis and binary Logistic regression were used to identify independent risk factors for ADR in the renal transplant group. RESULTS After PSM， 48 patients were included in each group. There were no statistically significant differences in the mean voriconazole trough concentration， target attainment rate or efficacy rate between the two groups （P＞0.05）. The total incidence of ADR was significantly higher in the renal transplant group than in the non-renal transplant group （P＜0.05）. Multiple linear regression analysis showed that age， average daily dose， pulmonary infection， total bilirubin during medication， day-1 loading dose， use of the original drug， concomitant immunosuppressant use， and the occurrence of ADR were factors influencing voriconazole trough concentration in renal transplant patients （P＜0.05）. Binary Logistic regression analysis showed that abnormal direct bilirubin during medication [OR＝7.747， 95%CI （1.334， 45.005）， P＝0.023] was an independent risk factor for ADR in renal transplant patients receiving voriconazole. CONCLUSIONS Age， average daily dose， pulmonary infection， use of the original drug， day-1 loading dose， total bilirubin during medication， concomitant immunosuppressant use， and the occurrence of ADR are the factors influencing voriconazole trough concentration in renal transplant patients. Furthermore， patients with abnormal direct bilirubin during medication are more susceptible to ADR. |
| 期刊： | 2025年第36卷第18期 |
| 作者： | 孙秀漫；曾彩芳；邓忠斌；石丽娟；石玉莹；陈靖雯；杨佳彬 |
| AUTHORS： | SUN Xiuman，ZENG Caifang，DENG Zhongbin，SHI Lijuan，SHI Yuying，CHEN Jingwen，YANG Jiabin |
| 关键字： | 伏立康唑；肾移植患者；血药谷浓度；药物不良反应 |
| KEYWORDS： | voriconazole； renal transplant patients； trough |
| 阅读数： | 10 次 |
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