摘要
目的探讨结缔组织病相关间质性肺病患者环孢素适宜血药谷浓度(ρ_0)范围及其影响因素,为间质性肺病患者合理使用环孢素提供依据。方法以2015年8月至2017年8月的41例用环孢素治疗并常规监测ρ_0的结缔组织病相关间质性肺病患者为研究对象,收集患者性别、年龄、ρ_0、生化指标以及不良反应等病历资料,分析ρ_0与各因素间的相互关系,评价血药浓度监测的临床指导意义。结果 41例患者共158次复诊结果,其中监测ρ_0 146例次。ρ_0在观察期内随着用药时间延长而下降,在用药360 d内,ρ_0多分布在50～100μg·L^(-1);用药超过360 d,ρ_0多分布在0～50μg·L^(-1);ρ_0水平随着日剂量和年龄的增大而升高;随着ρ_0升高,CD3^+CD4^+T淋巴细胞百分率和CD4^+/CD8^+的比值呈下降趋势,当ρ_0>150μg·L^(-1)时,感染风险增加;肺部感染和急性肾功能损伤是服药期间常见的不良反应。结论结缔组织病相关间质性肺病患者的环孢素ρ_0不宜超过150μg·L^(-1),最佳血浆浓度可根据个体情况进行调整。定期监测ρ_0有助于环孢素的合理使用,减少不良反应发生。
AIM To investigate the optimal range and influencing factors of cyclosporine plasma concentration (p0 ) in patients with connective tissue disease-associated interstitial lung disease ( CTD-ILD ), and improve the rational use of cyclosporine. METHODS A total of 41 CTD-ILD patients who treated with cyclosporine and monitored p0 regularly were enrolled in this study from August 2015 to August 2017. Patient's gender, age, p0 , biochemical indicators, adverse drug reactions and other medical records were collected, and the relationship between po and clinical factors were analyzed to evaluate the clinical significance of blood drug monitoring. RESULTS A total of 146 cases of p0 were monitored among 158 subsequent visits in 41 patients. During the observation period, po decreased with the prolongation of medication time. Within 360 days of medication, the range of p0 was 50~100 μg · L^-1. When used for more than 360 days, the range of p0 was 0-50 μg· L^-1;p0 increased with the increase of daily dose and age. The percentage of CD3 + CD4 + T cell and the value of CD4 +/CD8 + decreased with the increase of p0. The risk of infection increased when pQ more than 150μg·L^-1. Pulmonary infection and acute renal impairment were the most common adverse drug reactions during medication. CONCLUSION The cyclosporine Po in patients w让h CTD-ILD should not exceed 150 μg·L^-1. The optimal plasma concentration can be adjusted according to the individual condition. Regular monitoring of p0 can help rational use of cyclosporine and reduce adverse drug reactions.
作者
宋周烨
徐媛
葛卫红
于锋
SONG Zhouye;XU Yuan;GE Weihong;YU Feng(School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198 , China;Department of Pharmacy, Drum Tower Hospital, Nanjing 210000 , China)
出处
《中国临床药学杂志》
CAS
2019年第2期110-114,共5页
Chinese Journal of Clinical Pharmacy
基金
2017年江苏省研究生创新实践计划(编号SJCX17_0217)
关键词
环孢素
血药浓度监测
结缔组织病相关间质性肺病
cyclosporine
blood concentration monitoring
connective tissue disease-associated interstitial lung disease
