目的:研究伏立康唑累积剂量的相关性,治疗持续时间,和碱性磷酸酶与伏立康唑诱导的骨膜炎。
方法:使用临床信息学工具确定了131名使用伏立康唑的患者。健康记录数据,包括年龄,性别,免疫状态,碱性磷酸酶,伏立康唑水平,伏立康唑剂量,频率,收集治疗持续时间。两名放射学学员对治疗期间的影像学研究进行了审查,伏立康唑诱发的骨膜炎的影像学特征得到了董事会认证的肌肉骨骼放射科医生的证实。长度,在身体中的位置,在骨骼中的位置,type,并记录骨膜炎病灶形态。伏立康唑诱发的偶发性骨膜炎被定义为在没有其他诊断的情况下,经过28天或更长时间的伏立康唑治疗后影像学上的新的骨膜炎。使用累积伏立康唑剂量进行单变量Firth的逻辑回归模型,治疗持续时间,平均ALP作为预测因子,事件VIP作为结果。
结果:有9例伏立康唑诱导的骨膜炎患者和122例无伏立康唑诱导的骨膜炎患者。身体中最常见的病变位置是肋骨(37%),形态为实心(44%)。累积伏立康唑剂量增加31.5g与发生骨膜炎的几率增加8%相关。增加治疗时间(63天)和较高的平均碱性磷酸酶(50IU/L)与骨膜炎的几率高7%和骨膜炎的几率高34%相关。分别。
结论:伏立康唑累积剂量增加,治疗持续时间,和平均碱性磷酸酶与伏立康唑诱导的骨膜炎的较高几率相关。
OBJECTIVE: To investigate the associations of cumulative voriconazole dose, treatment duration, and alkaline phosphatase with voriconazole-induced periostitis.
METHODS: One hundred and thirty-one patients with voriconazole use were identified using a clinical informatics tool. Health record data including age, sex, immune status, alkaline phosphatase, voriconazole levels, voriconazole dose, frequency, and treatment duration were collected. Imaging studies during the duration of treatment were reviewed by two radiology trainees and imaging features of voriconazole-induced periostitis were confirmed by a board-certified musculoskeletal radiologist. The length, location in the body, location in the bone, type, and morphology of periostitis lesions were recorded. Incident voriconazole-induced periostitis was defined as new periostitis on imaging after 28 days or more of voriconazole treatment in the absence of an alternative diagnosis. Univariate Firth\'s logistic regression models were performed using cumulative voriconazole dose, treatment duration, and average ALP as predictors and incident VIP as the outcome.
RESULTS: There were nine patients with voriconazole-induced periostitis and 122 patients without voriconazole-induced periostitis. The most common lesion location in the body was the ribs (37%) and morphology was solid (44%). A 31.5-g increase in cumulative voriconazole dose was associated with 8% higher odds of incident periostitis. Increased treatment duration (63 days) and higher average alkaline phosphatase (50 IU/L) were associated with 7% higher odds of periostitis and 34% higher odds of periostitis, respectively.
CONCLUSIONS: Increased cumulative voriconazole dose, treatment duration, and average alkaline phosphatase were associated with higher odds of voriconazole-induced periostitis.