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老年低蛋白血症患者发生伏立康唑相关肝损伤的独立危险因素分析
Analysis of independent risk factors for voriconazole-related liver injury in elderly patients with hypoproteinemia
- 中国药房 2024年35卷第24期 页码：3035-3040
- 作者机构：
1.郑州大学附属郑州中心医院药学部，郑州 450007
2.郑州大学附属郑州中心医院综合办公室，郑州 450007
- 作者简介：
主任药师，硕士。研究方向：药物分析学和药物基因组学。E-mail：zhou750423@126.com
- 基金信息：河南省科技发展计划项目(222102310224);河南省医学科技攻关计划项目(LHGJ20191056;LHGJ20230777);河南省高等学校重点科研项目(21B360010)
DOI：10.6039/j.issn.1001-0408.2024.24.12
中图分类号： R969.3;R978.5纸质出版日期：2024-12-30，
收稿日期：2024-07-17，
修回日期：2024-12-03，
- 稿件说明：
移动端阅览
周丽娟,何勐,张玮等.老年低蛋白血症患者发生伏立康唑相关肝损伤的独立危险因素分析 Δ[J].中国药房,2024,35(24):3035-3040.
ZHOU Lijuan,HE Meng,ZHANG Wei,et al.Analysis of independent risk factors for voriconazole-related liver injury in elderly patients with hypoproteinemia[J].ZHONGGUO YAOFANG,2024,35(24):3035-3040.
周丽娟,何勐,张玮等.老年低蛋白血症患者发生伏立康唑相关肝损伤的独立危险因素分析 Δ[J].中国药房,2024,35(24):3035-3040. DOI： 10.6039/j.issn.1001-0408.2024.24.12.
ZHOU Lijuan,HE Meng,ZHANG Wei,et al.Analysis of independent risk factors for voriconazole-related liver injury in elderly patients with hypoproteinemia[J].ZHONGGUO YAOFANG,2024,35(24):3035-3040. DOI： 10.6039/j.issn.1001-0408.2024.24.12.
摘要
目的
2
探讨老年低蛋白血症患者发生伏立康唑（VCZ）相关肝损伤的独立危险因素。
方法
2
选取2020年8月－2023年7月我院呼吸重症监护室使用VCZ治疗的侵袭性真菌感染的老年低蛋白血症患者，按用药后是否发生肝损伤分为A组（发生肝损伤）和B组（未发生肝损伤
）。采用Pearson相关分析法分析VCZ谷浓度（
c
min
）与炎症因子[C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素6（IL-6）
]
、肝功能指标[丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、谷氨酰转肽酶（GGT）、总胆红素（TBIL）
]
的相关性；采用
χ
2
检验进行单因素分析；采用Logistic回归分析影响肝损伤发生的独立危险因素。
结果
2
纳入320例患者，有56例患者发生了肝损伤，肝损伤发生率为17.50%。A组患者的VCZ
c
min
显著高于B组（
P
＝0.021）。CRP、PCT、IL-6、TBIL与VCZ
c
min
均存在相关性（
P
＜0.05）；CRP、PCT、IL-6、TBIL对VCZ
c
min
有显著影响（
P
＜0.05）；VCZ
c
min
、PCT、TBIL是影响肝损伤发生的独立危险因素（
P
＜0.05）；VCZ
c
min
≥3.76 mg/L的患者肝损伤风险显著增加。
结论
2
VCZ
c
min
、PCT、TBIL是影响老年低蛋白血症患者发生VCZ相关肝损伤的独立危险因素；对于PCT或TBIL高的患者，使用VCZ期间，应密切监测VCZ
c
min
和肝功能，以降低肝损伤的发生风险。
Abstract
OBJECTIVE
2
To explore the independent risk factors of voriconazole （VCZ）-related liver injury in elderly patients with hypoproteinemia.
METHODS
2
Elderly patients with invasive fungal infection and hypoproteinemia who were hospitalized in the respiratory intensive care unit of our hospital and treated with VCZ from August 2020 to July 2023 were selected. They were divided into group A （liver injury group） and group B （non-liver injury group） based on whether the liver injury occurred after using VCZ. Pearson correlation analysis was used to analyze the correlation between minimum concentration （
c
min
） of VCZ and inflammatory factor[C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）
]
， as well as liver function [alanine transaminase （ALT）， aspartate transaminase （AST）， alkaline phosphatase （ALP）， gamma-glutamyl transpeptidase （GGT）， total bilirubin （TBIL）
]
； univariate analysis was performed by using
χ
2
test； Logistic regression analysis was u
sed to analyze the independent risk factors affecting the occurrence of liver injury.
RESULTS
2
A total of 320 patients were included in the study， of whom 56 developed liver injury， with an incidence of 17.50%. The VCZ
c
min
in group A was significantly higher than group B （
P
＝0.021）. CRP， PCT， IL-6， and TBIL were correlated with VCZ
c
min
（
P
＜0.05）. CRP， PCT， IL-6， and TBIL had a significant impact on VCZ
c
min
（
P
＜0.05）. VCZ
c
min
， PCT， and TBIL were independent risk factors for liver injury （
P
＜0.05）. The patients with VCZ
c
min
≥3.76 mg/L had a significantly increased risk of liver injury.
CONCLUSIONS
2
VCZ
c
min
， PCT， and TBIL are independent risk factors for the occurrence of liver injury in elderly patients with hypoproteinemia. For patients with high PCT and TBIL， VCZ
c
min
and liver function should be closely monitored during VCZ treatment to reduce the risk of liver injury.
关键词
伏立康唑肝损伤老年低蛋白血症谷浓度炎症因子独立危险因素
Keywords
liver injuryelderlyhypoproteinemiaminimum concentrationinflammatory factorindependent risk factor
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