Li Yuanyuan, Zhang Ying, Zhao Jinxia, Bian Jialu, Zhao Yinyu, Hao Xu, Liu Boyu, Hu Lei, Liu Fang, Yang Changqing, Feng Yufei, Huang Lin
Department of Pharmacy, Peking University People's Hospital, Beijing, China.
School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China.
J Chemother. 2024 May;36(3):179-189. doi: 10.1080/1120009X.2023.2247208. Epub 2023 Aug 20.
Voriconazole (VRC) displays highly variable pharmacokinetics impacting treatment efficacy and safety. To provide evidence for optimizing VRC therapy regimens, the authors set out to determine the factors impacting VRC steady-state trough concentration (C) in patients with various albumin (Alb) level. A total of 275 blood samples of 120 patients and their clinical characteristics and genotypes of , , , , , , , and were included in this study. Results of multivariate linear regression analysis demonstrated that C-reactive protein (CRP) and total bilirubin (T-Bil) were predictors of the VRC C adjusted for dose in patients with hypoalbuminemia (Alb < 35 g/L) ( = 0.16, P < 0.001). Additionally, in patients with normal albumin level (Alb ≥ 35 g/L), it resulted in a significant model containing factors of the poor metabolizer (PM) genotype and CRP level ( = 0.26, P < 0.001). Therefore, CRP and T-Bil levels ought to receive greater consideration than genetic factors in patients with hypoalbuminemia.
伏立康唑（VRC）的药代动力学具有高度变异性，会影响治疗效果和安全性。为了为优化VRC治疗方案提供依据，作者着手确定影响不同白蛋白（Alb）水平患者VRC稳态谷浓度（C）的因素。本研究纳入了120例患者的275份血样及其临床特征以及 、 、 、 、 、 、 和 的基因型。多变量线性回归分析结果表明，在低白蛋白血症（Alb < 35 g/L）患者中，C反应蛋白（CRP）和总胆红素（T-Bil）是调整剂量后VRC血药浓度（C）的预测指标（ = 0.16，P < 0.001）。此外，在白蛋白水平正常（Alb ≥ 35 g/L）的患者中，得出了一个包含代谢不良者（PM） 基因型和CRP水平的显著模型（ = 0.26，P < 0.001）。因此，对于低白蛋白血症患者，CRP和T-Bil水平应比遗传因素得到更多考虑。
