| 摘要: |
| 目的：探讨伏立康唑血药浓度在监测儿童血液病临床治疗中的作用。方法：收集2019年2月至2020年8月接受伏立康唑治疗的62例血液病患儿的临床资料，应用高效液相色谱法测定伏立康唑谷浓度。根据伏立康唑剂量将患儿分为3组，分别为<4.0 mg/kg组，4.0~6.0 mg/kg组，＞6.0 mg/kg组，比较其临床特点。结果：总体血药浓度达标率为57.5%。伏立康唑剂量＞6.0 mg/kg组患儿的年龄、体质量、身高明显低于其他两组。联用糖皮质激素降低伏立康唑浓度，而合用美罗培南升高伏立康唑浓度。伏立康唑肝损伤发生率为12.3%，肝功能异常患儿的伏立康唑血药浓度与肝功能正常的患儿比较差异无统计学意义。结论：血液病儿童伏立康唑血药浓度达标率低。小龄儿更易出现伏立康唑浓度偏低，需更大的体质量剂量达到治疗浓度。临床中合并用药时会影响伏立康唑浓度，伏立康唑血药浓度监测有利于指导血液病儿童个体化用药。 |
| 关键词: 伏立康唑 治疗药物监测 血药浓度 血液病 儿童 联合用药 |
| DOI：doi:10.13407/ j.cnki. jpp.1672-108X.2022.06.003 |
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| 基金项目:北京市临床重点专科项目,京卫医〔2018〕204号。 |
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| Clinical Application of Therapeutic Drug Monitoring of Voriconazole in Children with Hematological Disease |
| Huang Zhizhuo, Huang Lin, Jia Yueping, Lu Aidong, Zhang Leping |
| (Peking University People’s Hospital, Beijing 100044, China) |
| Abstract: |
| Objective: To explore the role of therapeutic drug monitoring of voriconazole in children with hematological disease. Methods: Clinical data of 62 children with hematological disease treated with voriconazole from Feb. 2019 to Aug. 2020 were collected. The trough concentration of voriconazole was determined by high performance liquid chromatography. According to the dose of voriconazole, the children were divided into 3 groups: less than 4.0 mg/kg group, from 4.0 to 6.0 mg/kg group, more than 6.0 mg/kg group. Clinical characteristics were compared. Results: The overall blood concentration compliance rate was 57.5%. The age, body weight and height of children in voriconazole dose more than 6.0 mg/kg group were significantly lower than those in other two groups. The combination of glucocorticoids decreased voriconazole concentration, while the combination of meropenem increased voriconazole concentration. The incidence of liver injury for voriconazole was 12.3%. There was no statistically significant difference of voriconazole concentration between the children with normal and abnormal liver function. Conclusion: The overall blood concentration compliance rate of voriconazole in children with hematological disease is relatively low. Young children are more likely to have low voriconazole concentration and need a larger body mass dose to reach the therapeutic concentration. Voriconazole concentration could be affect by drug combination in clinical practice, the therapeutic drug monitoring of voriconazole in children with hematological disease is beneficial to guide the individual medicine therapy. |
| Key words: voriconazole therapeutic drug monitoring blood concentration hematological disease children drug combination |
