实用医学杂志 ›› 2021, Vol. 37 ›› Issue (9): 1168-1171.doi: 10.3969/j.issn.1006⁃5725.2021.09.015

• 临床研究 • 上一篇    下一篇

CYP2C19基因多态性对预测侵袭性肺曲霉病患者伏立康唑相关不良反应的作用

李祥,苏铎华, 邢贞建, 钟洪兰, 李昕洁    

  1. 广州市胸科医院1 药剂科,2 结核内科(广州 510095)

  • 出版日期:2021-05-10 发布日期:2021-05-10
  • 通讯作者: 李昕洁 E⁃mail:xjli999333@sohu.com
  • 基金资助:
    广东省转化医学创新平台培育建设项目(编号:粤卫函[2018]1254 号);广州市高水平临床重点专科和培育专科建设项目(编号:穗卫函[2019]1555 号);广东省药学会医院药学研究基金(编号:2019JZ03)

Voriconazole related adverse drug reactions among different CYP2C19 genes in patients with Aspergil⁃ lusinfection 

LI Xiang,SU Duohua,XING Zhenjian,ZHONG Honglan,LI Xinjie.   

  1. Department of Pharmacy Guagnzhou Chest Hospital,Guangzhou 510095,China 

  • Online:2021-05-10 Published:2021-05-10
  • Contact: Xinjie E⁃mail:xjli999333@sohu.com

摘要:

目的 探讨CYP2C19基因多态性检测对预测侵袭性肺曲霉患者伏立康唑相关不良反应的指导作用,为临床此类患者个体化用药提供依据。方法 采用回顾性非随机对照方法,选择我院2018年1月至 2019年10月诊断为侵袭性肺曲霉病并使用伏立康唑的患者,查阅所有患者在院期间的验单和病程记录,观 察是否发生不良反应及类型。结果 共筛选出168例符合要求的患者,其中基因组84例,对照组84例,两组 患者在年龄、性别、体质量差异无统计学意义(P > 0.05)。基因组患者快、中、慢代谢型占 39.29%、45.24% 和15.47%。168例患者发生ADR的类型上差异有统计学意义,以肝功能异常发生率最高(46.23%),其次是 肾功能异常(17.86%)和胃肠道不适(14.28%)。基因组和对照组的 ADR 发生率比较差异有统计学意义 P < 0.05),基因组发生ADR较多;基因组中快、中、慢代谢型患者间ADR发生率两两比较差异均有统计学意 义(P < 0.05),以快代谢型(24.2%)最小,其次是中间代谢型(52.6%),慢代谢型最高(53.8%)。结论 获知使 用伏立康唑的肺曲霉患者CYP2C19的基因型,有助于针对性处置药物相关ADR,提高用药的安全性。

关键词:

CYP2C19基因多态性, 伏立康唑, 不良反应

Abstract:

Objective To investigate the guiding role of CYP2C19 gene polymorphism in predicting vori⁃ conazole related adverse reactions in patients with Aspergillus infection and to provide evidence for individualized drug use in such patients. Methods Retrospective non⁃randomized control method was used to select the patients who were diagnosed as invasive pulmonary aspergillosis and used voriconazole in our hospital from January 2018 to December 2019. Clinical records and course records of all patients were consulted to determine whether there were adverse reactions and types. Results Totally 168 patients were selected,including 84 patients with detected gene polymorphism in experiment group and another 84 patients in control group. There was no significant difference in age,gender and weight between the two groups(P > 0.05). Fast,medium and slow metabolisms in genomic patients were 39.29%,45.24% and 15.47% respectively. There were significant differences in the types of adverse drug reactions(ADR)in 168 patients. The incidence of liver dysfunction was the highest(46.23%),followed by renal dysfunction(17.86%)and gastrointestinal discomfort(14.28%). There was significant difference in the incidence of ADR between the experiment group and the control group(P < 0.05)and that was higher in the exper⁃ iment group. Inter⁃group comparison of ADR incidence in patients with fast,medium and slow metabolism showed statistical significance(P < 0.05),and ADR incidence in patients with slow metabolism(53.8%)was the highest followed by those with intermediate metabolism(52.6%)and those with fast metabolism(24.2%). Conclusion Identification of genotype of CYP2C19 in patients with pulmonary Aspergillus using voriconazole is helpful for the targeted disposal of drug⁃related ADRs and improving the safety of drug use. 

Key words:

CYP2C19 gene polymorphism, voriconazole, ADR