应用伏立康唑、氟康唑治疗真菌感染患者的血清药物浓度与疗效分析

中华养生保健 ›› 2025, Vol. 43 ›› Issue (4): 48-51.

应用伏立康唑、氟康唑治疗真菌感染患者的血清药物浓度与疗效分析

郑金燕¹, 林宝芳², 庞晓军^1,*

1.钦州市第二人民医院临床药学科,广西钦州,535000;
2.钦州市第二人民医院药剂科,广西钦州,535000

出版日期:2025-02-16 发布日期:2025-02-14
通讯作者: ^*庞晓军,E-mail：pangxjun@163.com。
作者简介:郑金燕（1989—）,女,汉族,籍贯：广西壮族自治区钦州市,硕士研究生,主管药师,研究方向：抗感染方向。

Analysis of Serum Drug Concentration and Efficacy of Voriconazole and Fluconazole in the Treatment of Fungal Infections

Zheng Jin-yan¹, Lin Bao-fang², PANG Xiao-jun^1,*

1. Department of Clinical Pharmacology, The Second People's Hospital of Qinzhou, Qinzhou 535000, China;
2. Department of Pharmacy, The Second People's Hospital of Qinzhou, Qinzhou 535000, China

Online:2025-02-16 Published:2025-02-14

摘要/Abstract

摘要： 目的通过分析单独应用伏立康唑、氟康唑治疗的真菌感染患者的血药浓度,探讨血清药物浓度对患者抗真菌治疗的临床意义,促进个体化精准药物治疗。方法选择2022年5月—2023年12月钦州市第二人民医院应用伏立康唑、氟康唑口服或静脉注射治疗的真菌感染患者血液标本,检测其血药浓度。其中单独应用伏立康唑治疗的真菌感染患者血液标本360例,单独应用氟康唑治疗的真菌感染患者血液标本109例。采用均相酶免疫法（HEIA）检测伏立康唑、氟康唑的血清药物浓度,并对血药浓度达标率、临床床转归情况、病原学检查结果情况、药物相互作用情况、不良反应情况等进行统计分析。结果血药浓度情况：伏立康唑血药浓度达标率66.95%;氟康唑血药浓度达标率54.13%。临床床转归情况：应用伏立康唑治疗的有效率91.39%,无效率8.61%。应用氟康唑治疗的有效率87.16%,无效率12.84%。病原学检查结果情况：微生物样本送检率为95.10%;病原学阳性结果以烟曲霉居多,其次为白色念珠菌、白色假丝酵母菌、黄曲霉、马尔尼菲蓝状菌等。药物相互作用情况：与伏立康唑相互作用的药物：奥美拉唑、阿普唑仑、利福平、利伐沙班、多潘立酮。与氟康唑相互作用的药物：胺碘酮、伊伐布雷定。不良反应情况：使用伏立康唑、氟康唑患者中发生不良反应有14例。结论在对真菌感染患者应用抗真菌药物治疗之后,进行血清药物浓度检测对指导临床抗真菌感染的下一步治疗具有至关重要的意义。建议及时根据用药后患者的血清药物浓度调整给药方案,制订个体化给药方案,保证患者药物治疗的安全、有效、经济。

关键词: 药物浓度检测, 血清药物浓度, 均相酶免疫法

Abstract: Objective By analyzing the blood drug concentrations of patients with fungal infections treated with voriconazole and fluconazole alone, we aim to explore the clinical significance of serum drug concentrations in patients' antifungal treatment and promote individualized and precise drug therapy. Methods Blood samples from patients with fungal infections treated with oral or intravenous voriconazole and fluconazole from May 2022 to December 2023 were collected and their blood drug concentrations were detected. Among them, there were 360 blood samples from patients with fungal infections treated with voriconazole alone and 109 blood samples from patients with fungal infections treated with fluconazole alone. Homogeneous enzyme immunoassay (HEIA) was used to detect the serum drug concentrations of voriconazole and fluconazole, and the results were statistically analyzed. Results 469 samples were collected for testing. Among them, 360 blood samples from patients with fungal infections treated with voriconazole alone involved 170 patients. The number of patients with fungal infections treated with voriconazole alone who underwent blood drug concentration testing was relatively high; 109 blood samples from patients with fungal infections treated with fluconazole alone involved 86 patients. The number of patients with fungal infections treated with fluconazole alone who underwent blood drug concentration testing was relatively low; the serum drug concentration of voriconazole was controlled within the effective concentration range; the serum drug concentration of fluconazole was controlled within the effective concentration range; some patients using voriconazole and fluconazole had interactions with other drugs. Conclusion After the application of antifungal drugs in patients with fungal infections, the detection of serum drug concentrations is crucial for guiding the next step of clinical treatment of antifungal infections. It is recommended to adjust the drug regimen according to the serum drug concentrations of patients after medication in a timely manner, and develop individualized drug regimens to ensure the safety, effectiveness, and economy of drug treatment for patients.

Key words: drug concentration detection, serum drug concentration, homogeneous enzyme amplification immunoassay

中图分类号:

R519

郑金燕, 林宝芳, 庞晓军. 应用伏立康唑、氟康唑治疗真菌感染患者的血清药物浓度与疗效分析[J]. 中华养生保健, 2025, 43(4): 48-51.

Zheng Jin-yan, Lin Bao-fang, PANG Xiao-jun. Analysis of Serum Drug Concentration and Efficacy of Voriconazole and Fluconazole in the Treatment of Fungal Infections[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(4): 48-51.

参考文献

[1] 汪复,张婴元.实用抗感染治疗学[M].3版.北京:人民卫生出版社,2020:480-489.
[2] 陈恳,张相林,克晓燕,等.《伏立康唑个体化用药指南》解读[J].临床药物治疗杂志,2019,17(3):47-52,78.
[3] ”十三五”国家科技重大专项艾滋病机会性感染课题组.艾滋病合并马尔尼菲篮状菌病临床诊疗的专家共识[J].西南大学学报(自然科学版),2020,42(7):61-75.
[4] 中国医药教育协会感染疾病专业委员会.抗菌药物药代动力学/药效学理论临床应用专家共识[J].中国结核和呼吸杂志,2018,41(6):409-446.
[5] HENK, ZHANG XL, KE XY, et al.Individualized Medication of Voriconazole: A Practice Guideline of the Division of Therapeutic Drug Monitoring,Chinese Pharmacological Society[J].Ther Drug Mo nit,2018,40(6):663-674.
[6] H Ruth Ashbee,Rosemary A Barnes, Elizabeth M Johnson,et al. Therapeutic drug monitoring (TDM) of antifungal agents: guidelines from the British Society for Medical Mycolog[J].J Antimicrob Chemother,2014,69(5):1162-1176.
[7] 谢加力,张晓明,林彤远.某院六种治疗药物血清药物浓度监测情况分析[J].中国处方药, 2023, 21(2):79-82.
[8] DIAO L, BU Y S, WANG S M, et al.Analysis of influencing factors on voriconazole plasma concentrations[J].Chin J Mod Appl Pharm,2019,36(6):763-765.
[9] 刘兰兰,卢波,程国振,等.2例伏立康唑引起的精神症状不良反应并文献复习[J].海峡药学,2024,36(3):102-105.
[10] PATTERSON T F, THOMPSON G R III, DENNING D W, et al. Practice guidelines for the diagnosis and management of aspergillosis:2016 update by the infectious diseases society of America[J]. Clin Infect Dis, 2016, 63(4): e1-e60.
[11] 胡俊俊,张二锋.97例伏立康唑不良反应文献分析[J].中国药物滥用防治杂志,2023,29(2):224-227.
[12] 陈旭,何仁,杨薇薇,等.侵袭性真菌病患者伏立康唑不良反应分析及临床处理经验陈旭[J].中国现代应用药学, 2022, 39(03): 391-394.
[13] 柴双,展敬伦,肇丽梅,等. 5种三唑类抗真菌药物的药物不良反应分析[J].中国临床药理学杂志, 2022, 38(17): 2079-2083.