中国药物警戒 ›› 2019, Vol. 16 ›› Issue (11): 678-682.
DOI: 10.19803/j.1672-8629.2019.11.08

• 安全性评价与合理用药 • 上一篇    下一篇

异烟肼、利福平和吡嗪酰胺血药浓度的稳定性及差异分析

周俊, 刘元, 吕小会, 赵嫄, 熊朝刚, 雷倩, 王皓   

  1. 西安市胸科医院药剂科,陕西 西安 710100
  • 收稿日期:2019-11-27 修回日期:2019-11-27 出版日期:2019-11-20 发布日期:2019-11-27
  • 作者简介:周俊,男,主管药师,博士,临床用药分析和药物临床试验。
  • 基金资助:
    2017年陕西省科技计划自然科学基础研究项目（2017JQ8016）：内源性硫化氢在肺结核炎症中的作用及机制研究

Stability and Variation of Plasma Concentrations of Isoniazid, Rifampicin and Pyrazinamide

ZHOU Jun, LIU Yuan, LV Xiaohui, ZHAO Yuan, XIONG Chaogang, LEI Qian, WANG Hao   

  1. Department of Pharmacy, Xi’an Chest Hospital, Xi’an Shanxi 710100, China
  • Received:2019-11-27 Revised:2019-11-27 Online:2019-11-20 Published:2019-11-27

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摘要： 目的 探讨3种常用一线抗结核药物血药浓度的稳定性及其规律和差异,以评价和提高治疗药物监测（TDM）在指导临床抗结核药物的个体化应用上的价值。方法 通过对服用异烟肼、利福平或吡嗪酰胺的同一患者前后2次TDM监测结果差异的比较,分析3种抗结核药物血药浓度稳定性,同时进行了3种药物血药浓度稳定性的横向比较。结果 每种药物均存在前后2次检测血药浓度的较大差异情况,将前后2次TDM数据进行配对t检验,并未发现两组数据间差异有统计学意义（异烟肼：t=0.924,P=0.363;利福平：t=0.054,P=0.957;吡嗪酰胺：t=1.027,P=0.323）。进一步比较分析发现异烟肼和利福平的前后2次监测数据的变异程度较吡嗪酰胺更大。结论 在基于TDM监测的个体化治疗过程中,对于代谢变化及体内暴露水平波动较大的药物如异烟肼、利福平等,需根据具体情况实施再次或多次检测。

关键词: 临床合理用药, 治疗药物监测, 抗结核药物, 药物代谢动力学

Abstract: Objective To investigate the stability, regularity and variation of plasma drug concentration of three commonly used first-line anti-tubercular drugs, and to assess and improve the value of therapeutic drug monitoring (TDM) in guiding individualized applications of clinical anti-tubercular drugs. Methods By comparing the deviations of plasma concentrations between two times of testing, we analyzed the stability of plasma concentrations of three of three anti-tubercular drugs - isoniazid, rifampicin and pyrazinamide. Moreover, the extent to which isoniazid, rifampicin and pyrazinamide varied was compared by uniforming and analyzing the data by dividing the deviations of the Results of two-time tests by the average of the paired Results. Results It was found that each drug had a concentration disparity between the two-time testing. However, there was no significant differences between the two lines of data in paired t-test (isoniazid: t=0.924, P=0.363; rifampicin: t=0.054, P=0.957; pyrazinamide: t=1.027, P=0.323). Further analysis revealed that the variation of isoniazid and rifampicin was larger than that of pyrazinamide. Conclusion During individualized treatment based on TDM monitoring, drugs which have large fluctuation in metabolic changes and intracorporal exposure levels, such as isoniazid and rifampicin, need to be detected more than once as actually required.

Key words: rational clinical drug use, therapeutic drug monitoring, anti-tubercular drugs, pharmacokinetics

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