与年龄相关的万科米辛蛋白结合的变化:是时候认真对待了吗?
Jessica Gadsby1, Lucy Stachow1, Hussain Mulla2
1Department of Pharmacy, University Hospitals of Leicester, Leicester, United Kingdom; and.
Therapeutic drug monitoring
|April 22, 2024
概括
与成年人相比,新生儿和儿童的自由万科米辛度 (EFVC) 有显著差异. 依赖总米素度可能导致儿科患者的剂量不准确和潜在的毒性水平.
科学领域:
- 药理学 药理学是指药理学的学科.
- 临床药房 临床药房
- 药物监测 药物监测 药物监测
背景情况:
- 范科米辛 (VAN) 蛋白质结合因患者年龄和疾病严重程度而异.
- 基于药物总度的范科米辛剂量可能由于蛋白质结合的改变而不可靠.
- 自由万科米辛度更能表明药理活性.
研究的目的:
- 为了比较模型估计的自由米素度 (EFVC) 与假设的自由米素度 (AFVC).
- 评估不同患者群体 (新生儿,儿童,成年人) 标准万科米辛剂量假设的准确性.
- 评估年龄和严重疾病对万科米辛蛋白结合和自由度的影响.
主要方法:
- 从电子健康记录中回顾分析患者数据.
- 确定患者队列,包括新生儿,儿童和在重症监护和透析中的成年人.
- 使用六种已确定的药理动力学模型和基于50%的约束性假设的AFVC计算EFVC.
- 对EFVC预测因子的分析,包括白蛋白,总蛋白质和透析状态.
主要成果:
- 在成年人中,EFVC和AFVC显示微不足道的差异.
- 在儿科重症监护病房患者中观察到EFVC和AFVC之间的显著差异.
- 新生儿在EFVC和AFVC之间表现出很大的差异,超治疗性自由度的百分比更高.
- 在新生儿和儿童中,在治疗范围内的自由万科米的百分比比较低,远低于预期.
结论:
- 危急病的新生儿和儿童中,万科米辛的未结合分数比成年人中高.
- 总的万科米辛度不能可靠地反映儿科患者的药理活性自由度.
- 针对成人治疗范围的标准范科米辛剂量调整可能会导致新生儿和儿童的超治疗性和潜在毒性水平.
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