摘要
目的探讨对ICU侵袭性真菌病患者进行伏立康唑治疗药物浓度监测的临床意义。方法对诊断为侵袭性真菌病并使用伏立康唑治疗的68例ICU患者进行回顾性分析,按照是否监测伏立康唑药物谷浓度(voriconazole trough concentration,Cvmin)将患者分为对照组(CON)及治疗药物浓度监测组(TDM),其中TDM组患者在伏立康唑治疗期间监测Cvmin,并根据Cvmin调整药物剂量,最后比较两组患者的治疗失败率和药物不良事件发生率。并进一步将TDM组患者按照Cvmin水平分为3个亚组,分别为低于有效治疗浓度组(Cvmin<1mg/L),达到有效治疗浓度组(Cvmin在1~4mg/L)和高于有效治疗浓度组(Cvmin>4mg/L)。比较不同亚组之间年龄、性别、白蛋白水平和持续肾替代治疗率之间的差异,寻找影响血药浓度的因素。结果和CON组相比,TDM组患者具有更低的治疗失败率,17%vs 3%,P<0.01;以及较低的药物不良事件发生率,23%vs 5%,P<0.01。3个亚组患者在性别、年龄、体重、白蛋白水平和APAPCHEII评分方面无统计学差异。与达到有效治疗浓度组及高于有效治疗浓度组的患者相比,低于有效治疗浓度组的患者持续肾替代治疗率明显升高,100%vs 52%,P<0.05及100%vs 29%,P<0.05。结论对于使用伏立康唑治疗侵袭性真菌病的ICU患者,尤其是那些同时接受CRRT治疗的患者,有必要进行治疗药物浓度监测,并根据Cvmin结果适当调整剂量,使药物浓度维持在有效治疗范围内,增加治疗成功率,同时降低药物不良反应的发生率。
Objective To investigate the clinical significance of the therapeutic drug monitoring of voriconazole for antifungal treatments in ICU patients. Methods The clinical data of patients with invasive fungal diseases treated with voriconazole were retrospectively analyzed. A total of 68 patients were involved in this study and divided into two groups based on voriconazole trough concentrations （Cvmin）： the control group （n=30, without Cvmin, result）, the TDM group （n=38, measuredCvmin at least once and adjusted voriconazole dosage through Cvmin result）.The treatment failure rates and adverse effect rates of the two groups were compared. On the other hand, we divided the TDM group into three subgroups based on Cvmin ranges： subtherapeutic concentration group（Cvmin〈lmg/L）, target- therapeutic concentration group （1 mg/L ≤ C ≤4 mg/L）, and supertherapeutic concentration group（Cvmin〉4 mg/L）, and compared the age, body weight, gender, albumin, and continuous renal replacement rates in three subgroups. Results The treatment failure rates and adverse effect rates were significantly lower in the TDM group than those in the CON group （3% vs 17%, P〈0.01, and 5% vs 23%, P〈0.01, respectively）. There are no statistical differences in the gender, age, body weight, albumin, and APACHEII score among three subgroups. Compared with the target-therapeutic and supertherapeutic concentration group, the continuous renal replacement rates in the subtherapeutic concentration group was significantly increased（100% vs 52%, P〈0.05, and 100% vs 29%, P〈0.05, respectively）. Conclusion These results indicated that the therapeutic drug monitoring of vorieonazole played a crucial role in increasing the treatment successful rate and decreasing the adverse effect rate in ICU patients, especially for those received continuous renal replacement treatment at the same time.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2017年第7期604-610,共7页
Chinese Journal of Antibiotics
基金
国家自然科学基金项目(No.81600574)
