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摘要：目的 探讨采用伏立康唑抗真菌治疗的肝硬化患者血清伏立康唑谷浓度（C min ）的分布特征及影响
因素。方法 回顾性分析2015年1月至2017年12月于泰康仙林鼓楼医院采用伏立康唑抗真菌治疗的150例
肝硬化患者的临床资料。患者持续使用3天伏立康唑，在第4天给药前采集静脉血3 ml，行EDTA抗凝，
采用高效液相色谱法（high performance liquid chromatography，HPLC）检测伏立康唑C min ，CYP2C19基
因多态性采用MassARRAY分子量陈列基因分析。分析患者血清伏立康唑C min 分布及其影响因素，比较
患者用药前后肝肾功能变化。结果 150例肝硬化患者血清伏立康唑C min 为（1.58 ± 0.39）mg/ml，其中口
服用药患者平均C min 为（1.29 ± 0.27）mg/ml，静脉输注患者平均C min 为（2.70 ± 0.25）mg/ml，差异有统
计学意义（t = 13.072，P = 0.036）。不同年龄、CYP2C19基因型、是否使用肝药酶诱导剂和抑制剂
的肝硬化患者血清伏立康唑C min 水平差异有统计学意义（P ＜ 0.05）。使用伏立康唑前后肝硬化患
者血清ALT、AST、TBil、Cr及CrCl水平差异无统计学意义（P ＞ 0.05）。结论 肝硬化患者年龄、
CYP2C19基因型及是否使用肝药酶诱导剂和抑制剂对血清伏立康唑C min 影响较大。
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Abstract: Objective To investigate the distribution characteristics and influencing factors of valley
concentration (C min ) of serum voleconazole in patients with liver cirrhosis. Methods Clinical data of 150
cases with liver cirrhosis who underwent antifungal therapy with volconazole in Taikang Xianlin Drum Tower
Hospital from January 2015 to December 2017 were retrospectively analyzed. All patients continued to take
voliconazole for 3 days and 3 ml venous blood were collected before the fourth day of administration. EDTA
was used as anticoagulant. C min of serum voleconazole was detected by high performance liquid chromatography
(HPLC), and CYP2C19 genotype were analyzed by MassARRAY. The distribution characteristics and
influencing factors of valley concentration of serum voleconazole in patients with liver cirrhosis were analyzed.
The changes of liver function and kidney function before and after treatment were also compared. Results The
C min of serum voleconazole in 150 patients with liver cirrhosis was (1.58 ± 0.39) mg/ml. The C min was (1.29 ±
0.27) mg/ml in patients who took voleconazole orally and (2.70 ± 0.25) g/ml in patients who took voleconazole
by intravenous infusion, respectively. The difference was statistically significant (t = 13.072, P = 0.036). There were
significant differences in serum voleconazole C min between cirrhotic patients with different ages, CYP2C19 genotypes
and whether use liver drug enzyme inducer and inhibitor (P ＜ 0.05). There were no significant differences in serum
levels of ALT, AST, TBil, Cr and CrCl in patients with liver cirrhosis before and after volconazole treatment (P ＞
0.05). Conclusion Age, CYP2C19 genotype and whether to use liver drug enzyme inducer and inhibitor have great
influences on serum voriconazole C min in patients with liver cirrhosis.
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