伏立康唑血药浓度监测结果评析

颜苗; 王柠柠; 李紫薇; 蒋梦飞; 王峰; 张毕奎; 徐萍; 肖轶雯

doi:10.3969/j.issn.1006-0111.2016.05.010

伏立康唑血药浓度监测结果评析

doi: 10.3969/j.issn.1006-0111.2016.05.010

1.
中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学临床药学研究所, 湖南长沙 410011
2.
中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学药学院, 湖南长沙 410208
3.
中南大学湘雅二医院药学部, 湖南长沙 410011

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

1.
The Second Xiangya Hospital of Central South University, Changsha 410011, China;Institute of Clinical Pharmacy, Central South University, Changsha 410011, China
2.
The Second Xiangya Hospital of Central South University, Changsha 410011, China;School of Pharmaceutical Sciences of Central South University, Changsha 410208, China
3.
The Second Xiangya Hospital of Central South University, Changsha 410011, China

摘要: 目的通过对不同临床专科伏立康唑进行治疗药物监测（TDM），并比较调整剂量前后的血药谷浓度数据，阐明TDM对伏立康唑合理用药的必要性，并给出相关的临床提示。方法本研究通过回顾性分析伏立康唑TDM的数据，对收治入院的154位患者的435例次伏立康唑血药谷浓度测定结果做一个初期评估。结果肾移植科仅有4.3%的测定结果高于5.5 μg/ml，而有26.5%的测定结果低于1.0 μg/ml。感染科有52.3%的测定结果高于5.5 μg/ml，没有出现低于1.0 μg/ml的测定结果。结论 TDM对伏立康唑的合理用药十分必要，肾移植科患者伏立康唑TDM不在建议浓度区间的结果以低于1.0 μg/ml居多，而感染科患者则以高于5.5 μg/ml居多，临床上应予以重视。临床药师可根据TDM结果更密切地参与伏立康唑的临床用药。
- 伏立康唑 /
- 治疗药物监测 /
- 肾移植科 /
- 感染科
Abstract: Objective To clarify the necessity of therapeutic drug monitoring (TDM) of voriconazole, and give relevant clinical tips, by comparing the plasma concentration of different clinical specialties before and after adjustment of dose. Methods This is a retrospective study of voriconazole TDM data. It involves 435 cases voriconazole plasma trough concentration measurement results of 154 inpatients to make a preliminary assessment. Results 4.3% plasma concentration were higher than 5.5 μg/ml, 26.5% plasma concentration were less than 1.0 μg/ml in renal transplantation department; while 52.3% plasma concentration were higher than 5.5 μg/ml, no less than 1.0 μg/ml in infectious disease department. Conclusions Therapeutic drug monitoring is necessary for rational use of voriconazole. The majority of plasma concentrations in renal transplantation patients were <1.0 μg/ml, lower than recommended treatment concentration range; while most infectious disease patients have > 5.5 μg/ml, higher than recommended treatment concentration range. Clinical pharmacists can be more closely involved in the clinical use of voriconazole based on the results of the therapeutic drug monitoring.
- voriconazole /
- TDM /
- renal transplantation department /
- infectious disease department

[1]	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis,2008,46:327-360.[2] Theuretzbacher U, Ihle F, Derendorf H. Pharmacokinetic/pharmacodynamic profile of voriconazole[J]. Clin Pharmacokinet, 2006, 45:649-663.
[2]	Cocchi S, Codeluppi M, Venturelli C,et al. Fusarium verticillioides fungemia in a liver transplantation patient: successful treatment with voriconazole[J]. Diagn Microbiol Infect Dis,2011, 71:438-441.
[3]	Voriconazole (Package Insert), Revised Version[Z]. New York, NY: Pfizer, 2011.
[4]	Hyland R, Jones BC, Smith DA. Identification of the cytochrome P450 enzymes involved in the N-oxidation of voriconazole[J]. Drug Metab Dispos, 2003,31:540-547.
[5]	Van Gelder T, Le Meur Y, Shaw LM, et al. Therapeutic drug monitoring of mycophenolate mofetil in transplantation[J]. Ther Drug Monit, 2006, 28(2):145-154.
[6]	Thomson AH, Whiting B. Bayesian parameter estimation and population pharmacokinetics[J].Clin Pharmaeokinet,1992, 22(6):447-467.
[7]	纪宇,黄晓军.关于《血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)》治疗原则部分的解读[J].临床药物治疗杂志,2008,6(1):14-18.
[8]	骆雪萍,梅铭惠.重症监护病房侵袭性真菌感染特点及诊断[J].重庆医学,2010,39 (17):2389-2391.
[9]	Hamadad Y, Seto Y, Yago K,et al. Investigation and threshold of optimum blood concentration of voriconazole: a descriptive statistical metaanalysis[J]. J Infect Chemother,2012, 18:501-507.
[10]	Kim KH, Lee S, Lee S,et al. Voriconazole-associated severe hyponatremia[J]. Med Mycol,2012,50:103-105.
[11]	Matsumoto K, Ikawa K, Abematsu K,et al. Correlation between voriconazole trough plasma concentration and hepatotoxicity in patients with different CYP2C19 genotypes[J]. Int J Antimicrob Agents,2009,34:91-94.
[12]	Park WB, Kim NH, Kim KH,et al. The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial[J]. Clin Infect Dis,2012, 55:1080-1087.
[13]	De Pauw B, Walsh TJ, Donnelly JP, et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group[J]. Clin Infect Dis,2008, 46(12):1813-1821.
[14]	付双双,熊歆,翟所迪,等.伏立康唑患者血药浓度监测[J].中国临床药理学杂志,2013,29 (8):622-624.
[15]	蔡然,张杰根,刘晓蒙,等.42例伏立康唑治疗肺真菌感染患者的不良反应[J].临床药物治疗杂志,2013,11 (2):49-51.
[16]	解建,张明,李涛,等.伏立康唑治疗101例重症患者侵袭性真菌感染的临床分析[J].中华医院感染学杂志,2012,22 (4):811-813.
[17]	Dolton MJ,Ray JE,Chen SC,et al. Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring[J]. Antimicrob Agents Chemother, 2012,56(9):4793-4799.
[18]	Pai MP, Allen S. Voriconazole inhibition of tacrolimus metabolism[J]. Clin Infect Dis, 2003, 36:1089-1091.
[19]	Chang HH, Lee NY, Ko WC, et al. Voriconazole inhibition of tacrolimus metabolism in a kidney transplant recipient with fluconazole-resistant cryptococcal meningitis [J]. Int J Infec Dis, 2010,14(4):348 -350.
[20]	Venkataramana R, Zang S, Gayowski T, et al.Voriconazoleinhibition of the metabolism of Tacrolimus in a liver transplant recipient and in human liver microsomes [J].Antimicrob Agents Chemother,2002,46(9): 3091-3093.
[21]	王柠柠,梁武,颜苗,等.在本院患者中建立伏立康唑群体药物代谢动力学模型的初步探索[J].中南药学,2015,11(3):1174-1177.

[1]	丁华敏, 郭羽晨, 秦春霞, 宋志兵, 孙莉莉. 消风止痒颗粒通过降低白三烯水平对小鼠特应性皮炎急性瘙痒的治疗作用研究 . 药学实践与服务, 2024, 42(5): 211-216. doi: 10.12206/j.issn.2097-2024.202306031
[2]	陈春娟, 郑志新, 李骊. 平喘方联合孟鲁司特钠治疗儿童支气管哮喘患者的临床疗效观察 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202405035
[3]	唐淑慧, 凤美娟, 薛智霞, 鲁桂华. 帕博利珠单抗治疗所致免疫相关不良反应与中医体质的相关性研究 . 药学实践与服务, 2024, 42(5): 217-222. doi: 10.12206/j.issn.2097-2024.202311029
[4]	景凯, 杨慈荣, 张圳, 臧艺蓓, 刘霞. 黄芪甲苷衍生物治疗慢性心力衰竭小鼠的药效评价及作用机制研究 . 药学实践与服务, 2024, 42(5): 190-197. doi: 10.12206/j.issn.2097-2024.202310004
[5]	张艺昕, 关欣怡, 王博宁, 闻俊, 洪战英. 二氢吡啶类钙离子拮抗药物手性分析及其立体选择性药动学研究进展 . 药学实践与服务, 2024, 42(8): 319-324. doi: 10.12206/j.issn.2097-2024.202308062
[6]	陈莹, 许子华, 胡北, 崔亚玲, 高欢, 吴琼. 通便灵胶囊治疗便秘的药效与机制研究 . 药学实践与服务, 2024, 42(): 1-7. doi: 10.12206/j.issn.2097-2024.202404008
[7]	夏哲炜, 曾垣烨, 朱海菲, 李育, 陈啸飞. 核磁共振磷谱法测定磷酸氢钙咀嚼片中药物含量 . 药学实践与服务, 2024, 42(9): 399-401, 406. doi: 10.12206/j.issn.2097-2024.202404063
[8]	马兹芬, 许维恒, 金煜翔, 薛磊. 食管癌的靶向治疗与免疫治疗研究进展 . 药学实践与服务, 2024, 42(6): 231-237. doi: 10.12206/j.issn.2097-2024.202306008
[9]	宋泽成, 陈林林, 鲁仁义, 刘梦肖, 王彦. 脓毒症治疗的研究进展 . 药学实践与服务, 2024, 42(11): 1-5. doi: 10.12206/j.issn.2097-2024.202405059
[10]	陈怡君, 王卓, 何苗, 张宇, 田泾. 泌尿系统碎石术抗菌药物预防使用合理管控实践 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202402034
[11]	张岩, 李炎君, 刘家荟, 邓娇, 原苑, 张敬一. 药物性肝损伤不良反应分析 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202404034
[12]	张元林, 宋凯, 孙蕊, 舒飞, 舒丽芯, 杨樟卫. 基于真实世界数据的药物利用研究综述 . 药学实践与服务, 2024, 42(6): 238-243. doi: 10.12206/j.issn.2097-2024.202312010
[13]	郭灵怡, 刘艳超, 高路, 刘瑞瑶, 吕权真, 俞媛. 醋酸卡泊芬净单硬脂酸甘油酯纳米粒抗白色念珠菌感染的增效作用研究 . 药学实践与服务, 2024, 42(): 1-8. doi: 10.12206/j.issn.2097-2024.202310043
[14]	史生辉, 石飞, 雷琼, 王亚峰, 吴雪花. 青藏高原肺结核合并念珠菌感染患者的病原菌分布特点及耐药率分析 . 药学实践与服务, 2024, 42(6): 260-262, 272. doi: 10.12206/j.issn.2097-2024.202304014
[15]	杨凤艳, 张月, 陈恩贤, 缪雪蓉, 魏凯. 瑞马唑仑临床应用研究进展 . 药学实践与服务, 2024, 42(9): 365-374. doi: 10.12206/j.issn.2097-2024.202405026
[16]	尹小娟, 台力丽, 肖俊峰, 季波. 铜绿假单胞菌合并按蚊伊丽莎白菌肺部感染的病例分析 . 药学实践与服务, 2024, 42(5): 223-226. doi: 10.12206/j.issn.2097-2024.202310042
[17]	宋雨桐, 夏德润, 顾珩, 唐少文, 易洪刚, 沃红梅. 帕博利珠单抗与铂类化疗方案在晚期非小细胞肺癌一线治疗中的药物经济学评价 . 药学实践与服务, 2024, 42(8): 334-340. doi: 10.12206/j.issn.2097-2024.202303023
[18]	孙丹倪, 黄勇, 张嘉宝, 王培. 代谢相关脂肪性肝病的无创诊断与药物治疗 . 药学实践与服务, 2024, 42(10): 411-418. doi: 10.12206/j.issn.2097-2024.202403049
[19]	张晶晶, 索丽娜, 郑兆红. 89例细菌性肝脓肿的临床特征及抗感染治疗分析 . 药学实践与服务, 2024, 42(6): 267-272. doi: 10.12206/j.issn.2097-2024.202302039
[20]	桂明珠, 李静, 李志玲. 儿童伏立康唑的血药浓度与CYP2C19、CYP2C9和CYP3A5基因多态性的相关性研究 . 药学实践与服务, 2024, 42(): 1-5. doi: 10.12206/j.issn.2097-2024.202402020

点击查看大图

计量

文章访问数: 4076
HTML全文浏览量: 571
PDF下载量: 917
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

伏立康唑血药浓度监测结果评析

doi: 10.3969/j.issn.1006-0111.2016.05.010

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

计量

伏立康唑血药浓度监测结果评析

doi: 10.3969/j.issn.1006-0111.2016.05.010

1. 中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学临床药学研究所, 湖南长沙 410011

2. 中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学药学院, 湖南长沙 410208

3. 中南大学湘雅二医院药学部, 湖南长沙 410011

English Abstract

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

全文HTML

目录

留言板

伏立康唑血药浓度监测结果评析

doi: 10.3969/j.issn.1006-0111.2016.05.010

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

计量

出版历程

伏立康唑血药浓度监测结果评析

doi: 10.3969/j.issn.1006-0111.2016.05.010

1. 中南大学湘雅二医院药学部, 湖南 长沙 410011;中南大学临床药学研究所, 湖南 长沙 410011 2. 中南大学湘雅二医院药学部, 湖南 长沙 410011;中南大学药学院, 湖南 长沙 410208 3. 中南大学湘雅二医院药学部, 湖南 长沙 410011

English Abstract

The evaluation and analysis on the results of voriconazole plasma concentration monitoring

全文HTML

目录

1. 中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学临床药学研究所, 湖南长沙 410011

2. 中南大学湘雅二医院药学部, 湖南长沙 410011;中南大学药学院, 湖南长沙 410208

3. 中南大学湘雅二医院药学部, 湖南长沙 410011