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中国临床药理学与治疗学 ›› 2022, Vol. 27 ›› Issue (11): 1264-1271.doi: 10.12092/j.issn.1009-2501.2022.11.008

• 临床药理学 • 上一篇    下一篇

重症患者体内米卡芬净暴露量有限采样法估算模型的建立

何杰1,刘冬雪2,钟羚君1,邵华1,胡琳璘1,3   

  1. 1东南大学附属中大医院药学部,南京 210009,江苏;
    2中国药科大学基础医学与临床药学学院,南京 211198,江苏;
    3东南大学附属中大医院临床试验机构办公室,南京 210009,江苏

  • 收稿日期:2022-05-31 修回日期:2022-07-31 出版日期:2022-11-26 发布日期:2022-12-12
  • 通讯作者: 胡琳璘,女,博士,副主任药师,研究方向:药代动力学、Ⅰ期临床试验研究。 Tel: 025-83272127 E-mail: eliza50@sina.com 邵华,女,博士,主任药师,研究方向:临床药学。 Tel: 025-83262632 E-mail: gycsh@163.com
  • 作者简介:何杰,女,硕士,药师,研究方向:药物分析。 Tel: 025-83272127 E-mail: 13011014975@163.com
  • 基金资助:
    2021年南京市药学会项目(2021YX020);江苏省药学会-奥赛康临床药学基金(A201904);北京慈华医学发展基金会科研项目(CHSJDC001)

Establishment of a limited sampling strategy to estimate micafungin exposure in critically ill patients

HE Jie1, LIU Dongxue2, ZHONG Lingjun1, SHAO Hua1, HU Linlin1,3   

  1. 1Department of Pharmacy, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China; 2School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 211198, Jiangsu, China; 3Office of Clinical Trial Institution, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China
  • Received:2022-05-31 Revised:2022-07-31 Online:2022-11-26 Published:2022-12-12

摘要:

目的:建立超高效液相色谱法监测重症感染患者米卡芬净血药浓度,并采用有限采样法估算其AUC。方法:重症感染患者静脉输注米卡芬净150 mg,每日1次,输注时间为1 h,稳态后分别于给药前、给药后1、2、4、8、12和24 h收集患者血液样本,建立UPLC法测定米卡芬净血药浓度,并采用Phoenix WinNonlin 6.4软件计算药动学参数,用SPSS 22.0软件对2~4个采血点的药物浓度进行多元线性回归方程建立有限采样模型。结果:血浆中米卡芬净线性范围为1.0~50 mg/L(r2=0.994),定量下限为1.0 mg/L,米卡芬净提取回收率为73.20%,精密度相对标准偏差(RSD)均小于15%。分别采用2~4个时间点的血药浓度估算AUC,其中2个时间点的方案C4、C12,3个时间点的方案C4、C12、C24,4个时间点的方案C4、C8、C12、C24预测性能良好,r2分别为0.986,0.995,0.996。结合预测精准性和可操作性,推荐3个时间点方案,其方程为4.578+7.263×C4+9.684×C12+6.411×C24。结论:本研究建立的测定方法专属性强、准确度高,操作简便,灵敏度高,可用于临床米卡芬净血药浓度的测定,并通过所建立的有限采样模型推荐给药后4、12、24 h的浓度估算AUC0-24,为优化米卡芬净给药方案提供基础。

关键词: 米卡芬净, 超高效液相色谱法, 治疗药物浓度监测, 有限采样法

Abstract: AIM: To establish an ultra high performance liquid chromatography (UPLC) method for the determination of micafungin in plasma of critically ill patients. And to establish a model for estimating the area under the concentration-time curve (AUC) of micafungin by limited sampling strategy.  METHODS: Patients with severe infection were administrated with micafungin once a day, 1 h for each infusion. The blood samples were collected before administration and 1, 2, 4, 8, 12, 24 h after administration and were measured by UPLC.The pharmacokinetic parameters were calculated by Phoenix winnonlin 6.4, and the drug concentrations at 2-4 blood collection points were analyzed with SPSS 22.0 to establish limited sampling models. RESULTS: The calibration curve was linear over a concentration range of 1.0 to 50 μg/mL (r2=0.994) and the lower limit of quantification was 1.0 mg/L.The recovery rate was 73.20%, and the precision relative standard deviation (RSD) were both lower than 15%. AUC was estimated by blood drug concentration at 2-4 time points, of which C4, C12 at 2 time points, C4, C12, C24 at 3 time points, C4, C8, C12, C24 at 4 time points had good prediction performance, and r2 was 0.986, 0.995, 0.996 respectively. Combining the prediction accuracy and operability, the recommended 3 time-point scheme equation was 4.578+7.263×C4+9.684×C12+6.411×C24.CONCLUSION: The method is simple and quick, with high specificity and sensitivity, therefore it is suitable for the detection of micafungin in the human plasma. The AUC0-24 can be accurately estimated by the concentration of micafungin at 4, 12, 24 h after administration, which can be applicable to the guidance for individualized micafungin use in clinical practice.

Key words: micafungin, ultra high performance liquid chromatography, therapeutic drug monitoring, limited sampling strategy

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