一线抗结核药物血药浓度监测及低血药浓度的影响因素OA

Objective To evaluate therapeutic drug monitoring(TDM)of first-line anti-tuberculosis(anti-TB)agents in patients with tuberculosis and to identify factors associated with subtherapeutic drug concentrations.Meth-ods This retrospective study included 143 patients with tuberculosis who received standard anti-TB therapy and under-went TDM at Guangzhou Chest Hospital between May 2024 and November 2024.Data collected included plasma drug con-centrations and clinical characteristics such as age,sex,and comorbid diabetes,as well as liver function indices(alanine aminotransferase[ALT],aspartate aminotransferase[AST],total bilirubin[TBIL])and renal function indices(blood uric acid[BUA],creatinine clearance[Ccr]).Factors associated with subtherapeutic drug concentrations were ana-lyzed.Results After at least 5 days of continuous administration of isoniazid(INH),rifampicin(RFP),pyrazinamide(PZA),and ethambutol(EMB),the proportions of patients with subtherapeutic drug concentrations were 84.2％(112/133),74.6％(106/142),36.6％(49/134),and 73.4％(105/143),respectively.Among patients with tuberculosis and diabetes,the proportion of subtherapeutic PZA concentrations was 20.0％,significantly lower than that in patients without diabetes(41.3％)(x2=4.574,P＜0.05).Among patients with elevated serum uric acid levels,the proportion of subtherapeutic PZA concentrations was 29.3％,lower than that in patients with normal uric acid levels(57.1％)(x2=8.647,P＜0.05).Among patients with elevated total bilirubin levels,the proportion of subtherapeutic EMB con-centrations was 20.0％,lower than that in patients with normal bilirubin levels(75.4％)(x2=5.008,P＜0.05).Conclusion Subtherapeutic plasma concentrations of first-line anti-TB drugs are common in patients with tuberculo-sis.Blood glucose status and hepatic and renal function may influence drug exposure.Targeted implementation of TDM may facilitate individualized dosing strategies,thereby improving therapeutic efficacy and medication safety.