论文部分内容阅读
目的监测胃肠间质瘤(GIST)患者伊马替尼的血药浓度并探讨其临床意义。方法回顾性收集四川大学华西医院胃肠外科2010~2016年期间接受伊马替尼治疗的42例GIST患者的血药浓度及临床病理资料,总结常规门诊治疗的GIST患者的血药浓度分布特点,探讨不同伊马替尼剂量对血药浓度的影响,并分析血药浓度与临床疗效间的关系。结果 42例GIST患者血药浓度为199~7 435μg/L,平均为1 757μg/L;有10例患者存在血药浓度不足,稳定血药浓度水平低于1 000μg/L(低血药浓度)。有18例患者因无法耐受400 mg/d的标准剂量而减量至300 mg/d,低剂量(300 mg/d)治疗患者的血药浓度较标准剂量(400 mg/d)治疗患者略降低(P=0.222),但低剂量治疗患者和标准剂量治疗患者的低血药浓度的发生率比较差异并无统计学意义(P=0.347)。Cox分析结果显示,低血药浓度患者(低于1 000μg/L)与高血药浓度患者(高于1 000μg/L)的疾病进展时间比较差异无统计学意义〔HR=0.171;95%可信区间:(0.106,12.990);P=0.898〕。结论从本研究有限的数据结果来看,在常规门诊治疗过程中,伊马替尼血药浓度在不同GIST患者中存在很大的变异,既有血药浓度不足,也有血药浓度过高导致不良反应的情况,合理的血药浓度监测策略以及基于监测的个体化药物治疗方案可能使患者获益。
Objective To monitor the plasma concentrations of imatinib in patients with gastrointestinal stromal tumors (GIST) and to investigate its clinical significance. Methods The data of 42 patients with GIST treated with imatinib from 2010 to 2016 in gastroenterology department of West China Hospital of Sichuan University were collected retrospectively to collect the blood concentration and clinicopathological data of patients with GIST. To investigate the effects of different doses of imatinib on plasma concentration, and to analyze the relationship between plasma concentration and clinical efficacy. Results The plasma concentration of 42 GIST patients ranged from 199 to 7 435 μg / L with an average of 1 757 μg / L. In 10 patients, the plasma concentration was insufficient and the stable plasma concentration was lower than 1 000 μg / L (low serum concentration) . 18 patients were reduced to 300 mg / d due to the inability to tolerate a standard dose of 400 mg / d, and those in the low-dose (300 mg / d) -treated group were slightly more aggressive than the standard dose (400 mg / d) (P = 0.222). However, there was no significant difference in the incidence of low plasma concentrations between low-dose and standard-dose patients (P = 0.347). The results of Cox analysis showed that there was no significant difference in the progression of disease between patients with low plasma concentration (less than 1 000 μg / L) and those with high plasma concentration (higher than 1 000 μg / L) (HR = 0.171; 95% Letter interval: (0.106, 12.990); P = 0.898]. Conclusions From the limited data in this study, plasma concentrations of imatinib vary widely in patients with different GISTs during routine outpatient treatment, with both inadequate plasma levels and high plasma concentrations Adverse events, reasonable blood drug monitoring strategies, and monitoring based individualized drug regimens may benefit patients.