儿童患者伏立康唑治疗药物监测研究进展

Research Progress of therapeutic drug monitoring of voriconazole in pediatric patients

关键词:  伏立康唑|儿童|药动学|治疗药物监测|基因多态性

Key words:  voriconazole|pediatric|pharmacokinetics|therapeutic drug monitoring|gene polymorphism

摘要:

伏立康唑在成人体内呈现非线性药动学特征，主要在肝脏中代谢，受基因多态性和药物相互作用的影响，个体间及个体内差异较大。因此，治疗药物监测在伏立康唑临床应用中发挥重要作用。相比成人，儿童患者的药动学更加复杂，目前针对儿童群体的研究数据相对较少，对于儿童目标浓度范围及剂量的调整策略尚存在争议，故该群体使用伏立康唑存在较大风险。本文分别从治疗药物监测必要性、监测策略、剂量调整策略共3个方面分析了儿童患者中伏立康唑治疗药物监测研究进展，以期为儿童患者临床抗真菌感染治疗提供参考。

Abstract:

Voriconazole has a nonlinear pharmacokinetic profile with wide inter- and intra-individual varieties in adults, polymorphisms and drug-drug interactions complicate treatment since it is extensively metabolized by the liver. Therefore, therapeutic drug monitoring plays an important role in clinical practice of voriconazole. Compared with that in adults, the pharmacokinetic behavior of voriconazole in pediatric patients is more complicated. However, the data are limited so the target range of voriconazole concentration and recommendations for dose adjustments of voriconazole have not been well described for a large cohort of pediatric patients, which indicates that these patients might be at higher risk. This article analyzes the research progress of voriconazole therapeutic drug monitoring in pediatric patients from three aspects:the necessity of therapeutic drug monitoring, monitoring strategy, and dose adjustment strategy, in order to provide a reference for clinical antifungal infection treatment in pediatric patients.