Page 97 - 《中国药房》2023年20期

伏立康唑对肺移植患者术后他克莫司血药浓度影响的真实世界

研究
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郭冬杰 ，李朋梅，陈文倩，刘丽宏（中日友好医院药学部，北京 100029）
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中图分类号 R969.2；R969.3 文献标志码 A 文章编号 1001-0408（2023）20-2519-06
DOI 10.6039/j.issn.1001-0408.2023.20.13

摘 要 目的 为肺移植患者联用伏立康唑后他克莫司的剂量调整提供依据。方法 回顾性收集2020年1月至2022年12月在我
院联合使用了伏立康唑和他克莫司的肺移植患者资料。采用SPSS 21.0软件分析伏立康唑对他克莫司谷浓度、日剂量和标准化血
药浓度的影响，并对可能影响他克莫司标准化血药浓度的因素进行多元线性回归分析。结果 共纳入肺移植患者153例。联用伏
立康唑后，患者使用的他克莫司平均日剂量从3.37 mg降至0.76 mg，谷浓度和标准化血药浓度均显著升高（P＜0.000 1）。伏立康
唑日剂量与他克莫司标准化血药浓度呈显著负相关（P＝0.000 1，r＝－0.224）；伏立康唑谷浓度与他克莫司谷浓度（P＜0.000 1，
r＝0.316）、标准化血药浓度（P＜0.000 1，r＝0.249）均呈显著正相关。联用伏立康唑后，单肺移植患者的他克莫司标准化血药浓度
显著高于双肺移植患者，且口服伏立康唑后他克莫司的标准化血药浓度显著高于静脉滴注伏立康唑后（P＜0.05）；大部分肝肾功
能指标均无显著变化。多因素回归分析结果显示，伏立康唑谷浓度对他克莫司标准化血药浓度具有显著影响（P＜0.001）。结论
伏立康唑谷浓度对他克莫司的血药浓度和剂量调整影响较大，是影响他克莫司血药浓度的独立因素。临床应在联合伏立康唑后
对他克莫司减量，同时对两药进行治疗药物监测。
关键词 伏立康唑；他克莫司；肺移植；血药浓度；治疗药物监测

A real-world survey of the effect of voriconazole on tacrolimus blood concentration after lung
transplantation
GUO Dongjie，LI Pengmei，CHEN Wenqian，LIU Lihong（Dept. of Pharmacy， China-Japan Friendship Hospital，
Beijing 100029， China）

ABSTRACT OBJECTIVE To provide a reference for the dose adjustment of tacrolimus in patients who underwent lung
transplantation after combined use of voriconazole. METHODS The clinical data of lung transplantation patients who used
voriconazole and tacrolimus in our hospital from January 2020 to December 2022 were collected retrospectively. The effects of
voriconazole on the valley concentration， daily dose and standardized blood concentration of tacrolimus were analyzed by using
SPSS 21.0 software； multiple linear regression analysis was conducted for the factors that may affect the standardized blood
concentration of tacrolimus. RESULTS A total of 153 lung transplantation patients were included. After the combination of
voriconazole， the average daily dose of tacrolimus decreased from 3.37 mg to 0.76 mg， and valley concentration and standardized
blood concentration were increased significantly （P＜0.000 1）. The average daily dose of voriconazole was negatively correlated
with the standardized blood drug concentration of tacrolimus （P＝0.000 1，r＝－0.224）. The valley concentration of voriconazole
was positively correlated with valley concentration （P＜0.000 1，r＝0.316） and standardized blood concentration （P＜0.000 1，r＝
0.249） of tacrolimus. After combination with voriconazole， the standardized blood drug concentration of patients who underwent
single lung transplantation was significantly higher than those who underwent double lung transplantation， and the standardized
blood concentration of tacrolimus after oral administration of voriconazole was significantly higher than after intravenous drip of
voriconazole （P＜0.05）. Most liver and kidney function indicators showed no significant changes. The results of multiple factor
regression analysis showed that the valley concentration of voriconazole had a significant impact on the standardized blood
concentration of tacrolimus （P＜0.001）. CONCLUSIONS The valley concentration of voriconazole has greatest influence on the
blood concentration and dose adjustment of tacrolimus， which is an independent influencing factor. In clinical practice， the dose of
tacrolimus should be reduced in combination with
Δ 基金项目 首都卫生发展科研专项（No.首发2020-1-2031）
＊第一作者 副主任药师，硕士。研究方向：抗感染药物、ICU临床 voriconazole， and therapeutic drug monitoring should be
药学、抗菌药物治疗药物监测。E-mail：guodongjie1223@163.com conducted for both drugs.
# 通信作者 主任药师，博士。研究方向：代谢性疾病的新药筛选 KEYWORDS voriconazole； tacrolimus； lung transplantation；
与发现、药理学评价及疾病机制。E-mail：hongllh@126.com blood concentration； therapeutic drug monitoring

中国药房 2023年第34卷第20期 China Pharmacy 2023 Vol. 34 No. 20 · 2519 ·