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肾脏替代治疗对抗结核药物浓度的影响 被引量:3

The effect of renal replacement therapy on the plasma concentration of antituberculosis drugs
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摘要 目的 探讨肾脏替代治疗(RRT)对一线抗结核药物血药浓度的影响.方法 收集2009年9月至2013年9月持续性RRT合并肺结核患者30例,男19例,女11例,年龄18~75岁,规律RRT每周3次,每次4h.异烟肼300 mg空腹、顿服,利福平450 mg空腹、顿服,RRT前24 h服用吡嗪酰胺40 mg·kg^-1·次^-1,顿服,3次/周.监测RRT前后药物血药浓度,连续监测4周以上.结果 在RRT前服药,所测得RRT前1~4周异烟肼的血药浓度分别为(1.62±0.44)、(1.67±0.38)、(1.63±0.41)和(1.48±0.38)mg/L,RRT治疗后分别为(0.57±0.22)、(0.60±0.24)、(0.56±0.20)和(0.56 ±0.15) mg/L,差异有统计学意义(均P<0.05).每周3次RRT,每次RRT前服用吡嗪酰胺,连续4周监测RRT前的血药浓度分别为(16.08±4.95)、(16.32±5.73)、(14.89±4.53)和(13.81±5.83) mg/L,RRT治疗后分别为(3.73±1.57)、(3.57±1.53)、(3.22±1.00)和(2.81±1.34) mg/L,差异有统计学意义(均P<0.05).每次RRT后服用吡嗪酰胺,连续4周监测下一次RRT前的血药浓度分别为(15.57±3.47)、(14.10±2.27)、(14.73±2.36)、(15.9±3.02) mg/L,RRT治疗后分别为(2.45±1.14)、(2.19±1.07)、(1.87±1.52)和(2.33±1.30) mg/L,差异有统计学意义(均P <0.05).吡嗪酰胺RRT前给药的MIC为12.5 mg/L.RRT前服用利福平,所测得RRT前1~4周的血药浓度分别为(3.44±1.17)、(3.72±1.24)、(3.68±1.16)和(3.44±1.22) mg/L,RRT治疗后分别为(2.96±1.10)、(3.28±1.04)、(3.17±1.02)和(2.96±1.05) mg/L,差异均无统计学意义(均P >0.05).结论 RRT对一线抗结核药中异烟肼和吡嗪酰胺的血药浓度有不同程度的影响,对利福平的影响较小.利福平应在RRT前给药,异烟肼和吡嗪酰胺应在RRT后给药,可使药物达到了最佳有效浓度,有效维持RRT合并肺结核患者的抗结核治疗效果. Objective To explore the effect of renal replacement therapy(RRT) on the plasma drug concentration of first-line antituberculosis drugs.Methods Thirty patients treated with continuous RRT and who were complicated with pulmonary tuberculosis from 2009 September to 2013 September were enrolled in the study.There were 19 males and 11 females,aged 18-75 years.They received RRT 3 times a week,4 h each.The patients took isoniazid 300 mg and rifampin 450 mg one time every day,and pyrazinamide 40 mg · kg^-1 · d^-1 one time 24 h before RRT,3 times every week.The plasma concentration of the drugs were monitored before and after each RRT for 4 weeks.Results Taken before RRT,the plasma concentration of isoniazidbeforeRRP was (1.62 ±0.44),(1.67 ±0.38),(1.63 ±0.41),(1.48 ±0.38) mg/L respectively for 1-4 weeks;while that after RRT was (0.57 ± 0.22),(0.60 ± 0.24),(0.56 ± 0.20),(0.56 ± 0.15) mg/L(all P 〈 0.05).Taken before RRT,the plasma concentration of pyrazinamide before RRT was (16.08 ± 4.95),(16.32 ± 5.73),(14.89 ± 4.53),(13.81 ± 5.83) mg/L respectively for 1-4 weeks,while that after RRT was (3.73 ± 1.57),(3.57 ± 1.53),(3.22 ± 1.00),(2.81 ± 1.34) mg/L (all P 〈 0.05).Taken after RRT at once,the plasma concentration of pyrazinamide before RRT was (15.57 ±3.47),(14.10 ±2.27),(14.73 ±2.36),(15.9 ± 3.02) mg/L respectively for 1-4 weeks,while that after RRT was (2.45 ± 1.14),(2.19 ± 1.07),(1.87 ± 1.52),(2.33 ± 1.30) mg/L.Taken before RRT,the plasma concentration of rifampin was (3.44 ± 1.17),(3.72 ± 1.24),(3.68 ± 1.16),(3.44 ± 1.22) mg/L respectively for 1-4 weeks (all P 〈0.05),while that after RRT was (2.96 ± 1.10),(3.28±1.04),(3.17±1.02),(2.96±1.05) mg/L(allP〉0.05).Conclusions Continuous RRT has different effects on the plasma drug concentration of isoniazid and pyrazinamide.It almost has no effect on rifampin.To achieve the best plasma concentration and better anti-tuberculosis results,isoniazid and pyrazinamide should be taken after RRT,but rifampin before RRT.
出处 《中华结核和呼吸杂志》 CAS CSCD 北大核心 2015年第5期375-378,共4页 Chinese Journal of Tuberculosis and Respiratory Diseases
基金 RRT天津市卫生局科研基金项目(09KZ37)
关键词 透析 抗结核药 血药浓度 Renal dialysis Antituberculosis drugs Plasma concentration
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