利福平耐药结核病患者治疗后贝达喹啉血药浓度的影响因素分析及其与预后的关系

doi:10.3969/j.issn.1006-5725.2025.13.019

Abstract

Abstract:

Objective To conduct a retrospective analysis of the correlation among bedaquiline （BDQ） plasma concentrations， relevant clinical factors， and disease prognosis. Methods In this retrospective study， 22 patients diagnosed with rifampicin-resistant tuberculosis （RR-TB）， multidrug-resistant tuberculosis （MDR-TB）， or pre-extensively drug-resistant tuberculosis （pre-XDR-TB） were enrolled. These patients were admitted to the tuberculosis ward of our hospital between February 2022 and October 2024. All patients were administered a treatment regimen containing BDQ. The cohort comprised 6 RR-TB patients （27.27%）， 12 MDR-TB patients （54.55%）， and 4 pre-XDR-TB patients （18.18%）. Peripheral blood samples were collected 2 hours after the oral administration of Bedaquiline. The plasma concentration of Bedaquiline was measured using liquid chromatography-tandem mass spectrometry （LC-MS/MS）. Spearman correlation analysis was performed using R studio software with the ggplot2 and corrplot packages. The factors included the blood concentration of bedaquiline， electrocardiogram QTcF （QT interval corrected by the Fridericia method）， liver and kidney function parameters， weight， age， body mass index， sex， blood uric acid level， serum creatinine level， and other relevant indicators. Results In 22 patients treated with BDQ， the plasma concentration reached a peak after 1.5 weeks of administration， and gradually stabilized after 2 weeks. The plasma concentration was approximately 1-3 μg/mL. After 24 weeks of withdrawal of bedaquiline， patients were continued to monitor their bedaquiline concentration and found that BDQ blood concentration in peripheral blood was approximate 1 μg /mL up to 36 weeks. The serum concentration of BDQ was not correlated with age， body weight， BMI， ALT， AST， GGT， TDiL， urea， uric acid and QT interval， but correlated with sputum negative transformation and serum creatinine. The correlation analysis between serum concentration of BDQ and acid-fast staining of sputum smear showed， the difference was significant （r = 0.35， P < 0.05）. In addition， the correlation analysis between serum BDQ concentration and serum creatinine showed， the difference was significant （r = 0.34， P < 0.05）. The results of multiple linear regression analysis showed that BDQ blood concentration was positively correlated with Scr level， and Scr was an independent factor affecting BDQ blood concentration. 20 cases （90.9%， 20/22） were cured， 1 case died of Covid-19 virus infection， 1 case was recurrence. Conclusions Regimens containing bedaquiline seem to exhibit relatively high safety profiles and good tolerability among patients with rifampicin-resistant， multidrug-resistant， or pre-extensively drug-resistant tuberculosis， typically yielding favorable treatment outcomes. The BDQ shows a positive correlation with serum creatinine （SCr）. Consequently， close surveillance of BDQ levels and renal function remains of utmost importance throughout the treatment course.

Key words: rifampicin-resistant tuberculosis, BDQ, blood concentration, QTcF, serum creatinine

CLC Number:

Taixian YOU,Chengjie SHU,Minglong XU,Mei HUANG,Nana LI,Zhangli PENG. Analysis of clinical factors influencing bedaquiline plasma levels and their impact on patient prognosis[J]. The Journal of Practical Medicine, 2025, 41(13): 2073-2081.

Figures/Tables 6

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References 31

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特征	数值
总例数	22
男性/［例（%）］	10（45.5）
年龄/［M（P₂₅，P₇₅）］/岁	44（31.5，53）
≥ 45岁/［例（%）］	10（45.5）
BMI/［M（P₂₅，P₇₅）］/（kg·m²）	20.68（18.46，21.71）
BMI < 18.5 kg·m²/［例（%）］	6（27.27）
合并症/［例（%）］
糖尿病/［例（%）］	3（13.64）
慢性肺病	5（22.73）
慢性肾病	0（0）
慢性肝病	2（9.09）
恶性肿瘤	0（0）
初治/［例（%）］	7（31.82）
复治/［例（%）］	15（68.18）
分离株耐药的药物/［M（P₂₅，P₇₅）］	2（1.25，2）
RR?TB/［例（%）］	6（27.27）
MDR?TB/［例（%）］	12（54.55）
Pre?XDR?TB/［例（%）］	4（18.18）
痰涂片阳性/［例（%）］	12（54.55）
结核分枝杆菌核酸阳性/［例（%）］	18（81.82）
胸部CT提示肺部空洞/［例（%）］	14（63.64 ）
双肺病变/［例（%）］	21（95.45 ）
实验室检查/［M（P₂₅，P₇₅）］
血红蛋白/（g/L）	131（118.50，142.25）
白蛋白/（g/L）	39.3（38.40，42.00）
AST/（IU/L）	22（16.50，26.00）
ALT/（IU/L）	11.5（9.25，15.75）
总胆红素/（g/dL）	6.55（5.83，8.20）
基线/QTcF/ms	395.48（381.20，400.27）

治疗结果	数值
痰培养阴转时间/［M（P₂₅，P₇₅）］	2（1，3）
治愈/［例（%）］	20（90.9）
复发（痰培养阳性）/［例（%）］	1（4.55）
死亡/［例（%）］	1（4.55）

Analysis of clinical factors influencing bedaquiline plasma levels and their impact on patient prognosis

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