Hong-Chun Wang, Lei Wang, Meng Li, Lei Shi, Hui-Hui Sun, Hong-Xing Liu, Hong-Ling Ou
{"title":"[同种异体造血干细胞移植患者伏立康唑及其代谢物浓度监测的应用研究]。","authors":"Hong-Chun Wang, Lei Wang, Meng Li, Lei Shi, Hui-Hui Sun, Hong-Xing Liu, Hong-Ling Ou","doi":"10.19746/j.cnki.issn.1009-2137.2024.03.045","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To explore the application value of simultaneous monitoring of voriconazole (VRCZ) and voriconazole N-oxide (VNO) in efficacy and safety of VRCZ in the prevention and treatment of fungal infections in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients before engraftment (i.e., days +1 to +30 after transplantation).</p><p><strong>Methods: </strong>The influencing factors of VRCZ, VNO concentration and MR (C<sub>VNO</sub>/C<sub>VRCZ</sub>) and the difference of VRCZ in the prevention and treatment of fungal infection and liver and kidney injury were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the differences (the corresponding to the maximum of the Youden index on the curve was set as the cut-off value) to confirm the critical value.</p><p><strong>Results: </strong>The factors affecting VRCZ concentration (C<sub>VRCZ</sub>), VNO concentration (C<sub>VNO</sub>) and MR were patient weight, VRCZ daily dose, and transplantation type (all <i>P</i> < 0.05). C<sub>VRCZ</sub> and C<sub>VNO</sub> in the effective group were higher than those in the ineffective group (<i>P</i> < 0.001), the opposite of MR (<i>P</i> < 0.001); the liver and renal injury group had lower MR than the normal group (<i>P</i> < 0.05). ROC showed that C<sub>VRCZ</sub>, C <sub>VNO</sub> and MR had important value in predicting VRCZ in the prevention and treatment of invasive fungal infections in allo-HSCT patients before engraftment, and their cutoff of concentrations were 0.95 μg/ml, 1.35 μg/ml and 1.645, respectively (AUC: 0.9677, 0.7634, 0.9564). C<sub>VRCZ</sub> and MR can assist in indicating liver ［cutoff values: 0.65 μg/ml, 1.96 (AUC: 0.5971, 0.6663)］ and renal injury ［cutoff values: 0.95 μg/ml, 1.705 (AUC: 0.6039, 0.6164)］.</p><p><strong>Conclusion: </strong>The great value of simultaneous monitoring of VRCZ, VNO and MR can predict in the efficacy and safety of VRCZ in allo-HSCT patients before engraftment. The prediction accuracy of C<sub>VRCZ</sub> was higher than that of MR, followed by that of C<sub>VNO</sub>. Increased C<sub>VRCZ</sub> and decreased MR increase the risk of liver and kidney injury.</p>","PeriodicalId":35777,"journal":{"name":"中国实验血液学杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[The Application Study of Voriconazole and Its Metabolites Concentration Monitoring in Allogeneic Hematopoietic Stem Cell Transplantation Patients].\",\"authors\":\"Hong-Chun Wang, Lei Wang, Meng Li, Lei Shi, Hui-Hui Sun, Hong-Xing Liu, Hong-Ling Ou\",\"doi\":\"10.19746/j.cnki.issn.1009-2137.2024.03.045\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To explore the application value of simultaneous monitoring of voriconazole (VRCZ) and voriconazole N-oxide (VNO) in efficacy and safety of VRCZ in the prevention and treatment of fungal infections in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients before engraftment (i.e., days +1 to +30 after transplantation).</p><p><strong>Methods: </strong>The influencing factors of VRCZ, VNO concentration and MR (C<sub>VNO</sub>/C<sub>VRCZ</sub>) and the difference of VRCZ in the prevention and treatment of fungal infection and liver and kidney injury were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the differences (the corresponding to the maximum of the Youden index on the curve was set as the cut-off value) to confirm the critical value.</p><p><strong>Results: </strong>The factors affecting VRCZ concentration (C<sub>VRCZ</sub>), VNO concentration (C<sub>VNO</sub>) and MR were patient weight, VRCZ daily dose, and transplantation type (all <i>P</i> < 0.05). C<sub>VRCZ</sub> and C<sub>VNO</sub> in the effective group were higher than those in the ineffective group (<i>P</i> < 0.001), the opposite of MR (<i>P</i> < 0.001); the liver and renal injury group had lower MR than the normal group (<i>P</i> < 0.05). ROC showed that C<sub>VRCZ</sub>, C <sub>VNO</sub> and MR had important value in predicting VRCZ in the prevention and treatment of invasive fungal infections in allo-HSCT patients before engraftment, and their cutoff of concentrations were 0.95 μg/ml, 1.35 μg/ml and 1.645, respectively (AUC: 0.9677, 0.7634, 0.9564). C<sub>VRCZ</sub> and MR can assist in indicating liver ［cutoff values: 0.65 μg/ml, 1.96 (AUC: 0.5971, 0.6663)］ and renal injury ［cutoff values: 0.95 μg/ml, 1.705 (AUC: 0.6039, 0.6164)］.</p><p><strong>Conclusion: </strong>The great value of simultaneous monitoring of VRCZ, VNO and MR can predict in the efficacy and safety of VRCZ in allo-HSCT patients before engraftment. The prediction accuracy of C<sub>VRCZ</sub> was higher than that of MR, followed by that of C<sub>VNO</sub>. Increased C<sub>VRCZ</sub> and decreased MR increase the risk of liver and kidney injury.</p>\",\"PeriodicalId\":35777,\"journal\":{\"name\":\"中国实验血液学杂志\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中国实验血液学杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.19746/j.cnki.issn.1009-2137.2024.03.045\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中国实验血液学杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.19746/j.cnki.issn.1009-2137.2024.03.045","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
[The Application Study of Voriconazole and Its Metabolites Concentration Monitoring in Allogeneic Hematopoietic Stem Cell Transplantation Patients].
Objective: To explore the application value of simultaneous monitoring of voriconazole (VRCZ) and voriconazole N-oxide (VNO) in efficacy and safety of VRCZ in the prevention and treatment of fungal infections in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients before engraftment (i.e., days +1 to +30 after transplantation).
Methods: The influencing factors of VRCZ, VNO concentration and MR (CVNO/CVRCZ) and the difference of VRCZ in the prevention and treatment of fungal infection and liver and kidney injury were analyzed. The receiver operating characteristic curve (ROC) was used to analyze the differences (the corresponding to the maximum of the Youden index on the curve was set as the cut-off value) to confirm the critical value.
Results: The factors affecting VRCZ concentration (CVRCZ), VNO concentration (CVNO) and MR were patient weight, VRCZ daily dose, and transplantation type (all P < 0.05). CVRCZ and CVNO in the effective group were higher than those in the ineffective group (P < 0.001), the opposite of MR (P < 0.001); the liver and renal injury group had lower MR than the normal group (P < 0.05). ROC showed that CVRCZ, C VNO and MR had important value in predicting VRCZ in the prevention and treatment of invasive fungal infections in allo-HSCT patients before engraftment, and their cutoff of concentrations were 0.95 μg/ml, 1.35 μg/ml and 1.645, respectively (AUC: 0.9677, 0.7634, 0.9564). CVRCZ and MR can assist in indicating liver ［cutoff values: 0.65 μg/ml, 1.96 (AUC: 0.5971, 0.6663)］ and renal injury ［cutoff values: 0.95 μg/ml, 1.705 (AUC: 0.6039, 0.6164)］.
Conclusion: The great value of simultaneous monitoring of VRCZ, VNO and MR can predict in the efficacy and safety of VRCZ in allo-HSCT patients before engraftment. The prediction accuracy of CVRCZ was higher than that of MR, followed by that of CVNO. Increased CVRCZ and decreased MR increase the risk of liver and kidney injury.
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