【摘要】 目的评价广东省人民医院2014年1月至2017年12月的9 389例/次环孢素(cyclosporine A,Cs A)治疗药物监测和临床用药情况。方法对广东省人民医院1 719例患者9 389次的Cs A监测结果进行统计分析,并对501例血液病患者的性别、年龄、肝功能、合并用药变化对Cs A血药浓度影响的分析。结果首次治疗药物监测结果在有效治疗窗内的仅占30.8%;治疗药物监测次数为1、2、3和大于10次者分别占总人数的41.0%、16.9%、9.2%和14.4%;在所有监测次数为3～5次的患者中,第1、2、3、4、5次治疗药物监测结果在治疗窗内的分别占总人数的38.8%、38.9%、39.2%、37.1%、47.1%;性别、肝功能、合并用药变化对Cs A血药浓度均有显著的影响(P<0.05),年龄对Cs A血药浓度未有显著影响(P>0.05)。结论治疗药物监测虽然广泛应用,但监测次数偏少;即使监测多次,达标情况仍不理想,应高度重视这种不能很好调整患者用药的现象,这可能与Cs A血药浓度药动学参数个体差异和受多种因素影响有关。更多还原

【Abstract】 Objective To evaluate 9 389 cases of therapeutic drug monitoring(TDM) and the clinical drug usage of cyclosporine A(CsA) in Guangdong Provincial People’s Hospital during January 2014 to December 2017.Methods Analysis and statistics of CsA TDM data of 9 389 cases(1 719 subjects) in Guangdong Provincial People’s Hospital were carried out.The effects of gender,age,liver function and changes of combined medication on the blood concentration of CsA in 501 patients with hematological disease were analyzed.Results Among all the first TDM concentration,only 30.8% was within the therapeutic window.Constituent ratio of patients whose drug concentrations were monitored once,twice,three times or more than ten times respectively of 41.0%,16.9%,9.2 % and 14.4%.Among all the subjects undergoing 3～5 times of TDM,constituent ratio of patients whose drug concentrations of the first,second,third,fourth and fifth monitoring were within the therapeutic window accounted for 38.8%,38.9%,39.2%,37.1% and 47.1% respectively.Gender,liver function,and changes of combined medication had significant effect on the blood concentration of CsA(P<0.05),and age had no significant effect on the blood concentration of CsA(P>0.05).Conclusion Although TDM was widely used,the TDM times were insufficient.Even TDM was multiple,the status of which was not satisfactory.We should pay much more attention to the phenomenon that the patients’ medication was not adjusted properly.It may correlate with the individual difference of pharmacokinetic parameters of CsA,and many factors that can affect the concentration of CsA.更多还原