摘要目的 研究CYP2C 19基因型对血液病患者伏立康唑血药浓度的影响,并探讨伏立康唑血药浓度监测在侵袭性真菌病(IFD)防治中的价值.方法 回顾性分析2016年1月至12月接受伏立康唑静脉注射的65例血液病合并IFD患者临床资料.应用焦磷酸测序检测患者CYP2C 19基因型,超高效液相色谱-串联质谱法监测患者伏立康唑血清谷浓度.结果 65例患者中,CYP2C 19基因型伏立康唑快代谢型30例,中代谢型33例,慢代谢型2例,将中代谢型与慢代谢型归于非快代谢型组.共检测伏立康唑血药浓度169次,快代谢型组患者伏立康唑血清谷浓度明显低于非快代谢型组[0.98(0.38～ 2.08) mg/L对2.19(1.53 ～ 4.27) mg/L,z=10.286,P＜0.001].26例伏立康唑平均血清谷浓度＜ 1.5 mg/L患者,其治疗失败率(50.0％)明显高于伏立康唑平均血清谷浓度≥1.5 mg/L患者(20.5％)(P=0.052).5例伏立康唑平均血清谷浓度＞5.5 mg/L患者中,4例出现视觉障碍;60例伏立康唑平均血清谷浓度≤5.5 mg/L患者中,4例(6.1％)出现视觉障碍,1例(1.5％)出现中枢神经系统毒性,不良反应发生率差异有统计学意义(x2=11.689,P=0.020).结论 CYP2C 19基因快代谢型患者伏立康唑血清谷浓度明显低于CYP2C 19基因非快代谢型,恰当的伏立康唑血清谷浓度能减少药物不良反应,并降低抗真菌治疗的失败率.

abstractsObjective To evaluate the effects of CYP2C 19 genetic polymorphism on the plasma concentration of voriconazole in patients with hematological disease and the value of serial monitoring plasma concentrations in the treatment and prevention of invasive fungal disease (IFD).Methods From January 2016 to December 2016,65 hematological patients who received voriconazole intravenous administration for the treatment of invasive fungal disease were enrolled in this study.The population CYP2C 19 polymorphism of voriconazole were performed using PCR-Pyrosequencing.The trough plasma concentrations of vriconazole (C,rough) was detected by ultra performance liquid chromatography tandem mass spectrometry.Results Based on the genotype analysis,65 subjects were identified as extensive metabolizers' group (30 cases) and poor metabolizers' group (35 cases).The C of the 65 patients were detected for 169 times totally,and there was a significant difference of Ctrough values between the two groups [0.98(0.38-2.08) mg/L vs 2.19(1.53-4.27) mg/L,z=10.286,P＜0.001].The medium of Ctrough in 65 hematological patients were described.Lack of response to therapy was more frequent in patients with voriconazole levels ＜ 1.5 mg/L (50.0％) than in those with voriconazole levels ＞ 1.5 mg/L (20.5％) (P=0.052).And the risk of adverse events was more frequent in patients with voriconazole levels ＞ 5.5 mg/L (80.0％) than in those with voriconazole levels ≤5.5 mg/L (8.3％) (x2 =11.689,P=0.020).Conclusion Patients with CYP2C19 wild-type phenotype are extensive metabolizers,their Ctrough of voriconazole are significantly lower than patients with CYP2C 19 non-wild-type phenotype (poor metabolizers).Appropriate concentrations of vriconazole can improve the efficacy and safety during treatment.