[1]程林,翁邦碧,向荣凤,等.老年肺部侵袭性真菌感染患者伏立康唑谷浓度与肝功能损伤的关系[J].第三军医大学学报,2020,42(19):1944-1949.
 CHENG Lin,WENG Bangbi,XIANG Rongfeng,et al.Relationship between voriconazole trough concentration and liver injury in elderly patients with lung invasive aspergillosis[J].J Third Mil Med Univ,2020,42(19):1944-1949.
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老年肺部侵袭性真菌感染患者伏立康唑谷浓度与肝功能损伤的关系(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
42卷
期数:
2020年第19期
页码:
1944-1949
栏目:
临床医学
出版日期:
2020-10-15

文章信息/Info

Title:
Relationship between voriconazole trough concentration and liver injury in elderly patients with lung invasive aspergillosis
作者:
程林翁邦碧向荣凤孙凤军
陆军军医大学(第三军医大学)第一附属医院药学部 
Author(s):
CHENG Lin WENG Bangbi XIANG Rongfeng SUN Fengjun
Department of Pharmacy, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
 
关键词:
伏立康唑肺部感染老年治疗药物监测不良反应肝功能损伤
Keywords:
voriconazole lung infection aged therapeutic drug monitoring adverse effect liver injury
分类号:
R563.1; R575; R978.5
文献标志码:
A
摘要:

目的探讨老年肺部侵袭性真菌感染患者伏立康唑谷浓度与肝功能损伤的相关性。方法对2018年1月1日至2019年6月30日我院收治的符合入选标准的进行伏立康唑治疗药物监测成年患者的临床资料进行回顾性分析。根据年龄将患者分为老年组(≥60岁)和成年组(≥18~<60岁)。比较2组患者的给药方式、给药剂量、伏立康唑谷浓度、肝功能指标异常发生情况。结果共纳入179例肺部侵袭性真菌感染患者,329个伏立康唑谷浓度。老年组患者87例,131个谷浓度;成年组患者92例,198个谷浓度。老年组患者伏立康唑给药方式以静脉滴注为主,静脉滴注百分比高于成年组(P<0.01)。2组患者伏立康唑给药剂量相近(P>0.05)。老年组患者伏立康唑谷浓度为3.86(2.02,6.00)μg/mL,明显高于成年组患者的2.6(1.5,4.0)μg/mL(P<0.01);老年组伏立康唑谷浓度>5.0 μg/mL患者比例高于成年组(P<0.01)。老年组患者谷丙转氨酶(ALT)升高发生率小于成年组(P<0.01),白蛋白下降发生率高于成年组(P<0.01)。伏立康唑谷浓度>5.0 μg/mL时,老年组患者碱性磷酸酶(ALP)、ALT、谷氨酰转肽酶(GGT)升高和白蛋白下降百分比增高(P<0.05)。老年组患者肝功能指标ALP、ALT、谷草转氨酶(AST)、GGT、总胆红素和白蛋白与伏立康唑谷浓度不相关(r=0.018、0.154、0.166、-0.171、-0.138、-0.118,P>0.05)。成年组患者伏立康唑谷浓度与AST、总胆红素水平呈正相关(r=0.267、0.618,P<0.01),与白蛋白浓度呈负相关(r=-0.214,P<0.05)。结论老年患者伏立康唑谷浓度高于成年患者;伏立康唑谷浓度>5.0 μg/mL时,老年患者更容易发生肝功能损伤;老年患者伏立康唑谷浓度与肝功能指标不相关。

Abstract:

ObjectiveTo investigate the relationship between voriconazole trough concentration and liver injury in elderly patients with lung invasive aspergillosis. Methods The clinical data of patients receiving voriconazole therapeutic drug monitoring matched with our inclusion criteria, who admitted to our hospital from 1 January, 2018 to 30 June, 2019 were collected and retrospectively analyzed. The patients were divided into elderly group (≥60 years old) and adult group (≥18~<60 years old). The route of administration, daily dose and trough concentration of voriconazole, and abnormal indexes in liver function were compared between the 2 groups. ResultsA total of 179 patients with lung invasive aspergillosis were included in, with 329 voriconazole trough concentration. There were 87 patients in the elderly group, with 131 voriconazole trough concentration, and 92 patients in the adult group, with 198 trough concentrations. Most patients in the elderly group received an intravenous drip, with a higher rate than that in the adult group (P<0.01). The voriconazole dose was similar in the 2 groups (P>0.05). The voriconazole trough concentration was 3.86 (2.02~6.00) μg/mL in the elderly group, significantly higher than that in the adult group [2.6 (1.5~4.0) μg/mL, P<0.01]. The proportion of the trough concentrations higher than 5 μg/mL was higher in the elderly group than the adult group (P<0.01). The incidence rate of increased alanine aminotransferase (ALT) level was lower in the elderly group than the adult group (P<0.01), but the rate of decreased albumin were opposite between the 2 groups (P<0.01). For those with the trough concentrations higher than 5 μg/mL, the incidences of increased alkaline phosphatase (ALP), ALT, and gamma-glutamyl transpeptidase (GGT) concentrations and decreased albumin level were higher in the elderly group than the adult group (P<0.05). There were no correlations of voriconazole trough concentration with ALP, ALT, aspartate aminotransferase (AST), GGT, total bilirubin, and albumin in the elderly group (r=0.018, 0.154, 0.166, -0.171, -0.138, -0.118, P>0.05). And positive correlation were observed in the voriconazole trough concentration with AST and total bilirubin in adult group (r=0.267, 0.618, P<0.01), and negative correlation between the trough concentration and albumin level in adult group (r=-0.214, P<0.05). ConclusionThe voriconazole trough concentration is higher in the elderly than adult patients. For the elderly patients with the voriconazole trough concentration was higher than 5.0 μg/mL, they were prone to liver injury. But there are no correlations of voriconazole trough concentration and liver function indexes in them. 

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更新日期/Last Update: 2020-10-02