本研究總收案人數 42 人，完成療劑監測之有效樣本共 41 位，包含 23 位預 防性及 18 位治療性使用 posaconazole 者。研究期間共有 103 筆濃度資料，預防 性使用 53 筆，中位數為 643ng/mL (137-2397)，達到文獻建議目標比例為 43.4%；
治療性使用 50 筆，中位數為 711.5 ng/mL(0-3223)，目標達成率 22%。另外，同 一病人的濃度變化可達 0.9-10.7 倍。
預防性使用部分，共 33 件預防事件（化學治療 27 件，移植後 GVHD 組 6 件），本研究 posaconazole 預防失敗率為 15.2%，預防失敗組 posaconazole 濃度目
標達成率為 0%（成功組 64.3%），且失敗組濃度較成功組低，達統計上顯著。但
在納入其他預後因子分析後，posaconazole 濃度未達統計顯著意義，只剩病人年 齡會影響預後（OR 1.156，1.02-1.31，p= 0.023）。
18 位治療性使用 posaconazole 病人中，13 位 (72.2)%有潛在血液疾病，適 應症以可能感染（44.4%）和確定感染（38.9%）為主，使用 posaconazole 原因以 前線治療失敗或出現副作用（55.6%）居多。本研究治療成功率為 50%，濃度在 治療成功、失敗組的分佈未達統計上顯著不同，且納入其他預後因子後，濃度無 統計上顯著意義。
Posaconazole 血中濃度在相同劑量下個體差異性大，同一病人的濃度變化也 可達 0.9-10.7 倍。併用 PPI、腹瀉、口腔黏膜炎、食物攝食量顯著影響濃度分佈，
經 multiple linear regression 分析後，年紀越大、併用 PPI、併用酵素誘導劑、腹 瀉和濃度降低顯著有關；食物攝取量提高濃度則顯著上升。MDR1 2677G>T/A 與濃度分佈有顯著關係，UGT1A4、1236C>T、 3435C>T/A 基因多型性則沒有 顯著。
研究期間觀察到 12 件和 posaconazole 使用相關之不良反應，包含 ALT 上升 6 件（11.8%）、AST 上升 2 件（3.9%）、低血鉀 4 件（7.8%），皆沒有導致停藥。
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出現 posaconazole 相關不良反應與否，在血中濃度分佈上無顯著差異。
本研究中 posaconazole 血中濃度越高，預防黴菌感染效果越好。血中濃度和 治療效果的關係則無顯著意義。Posaconazole 濃度在個體內及個體間差異性大，
年紀、腸胃道功能、併用藥品和攝食量扮演重要角色，因此 posaconazole 血中濃 度監測在預防性使用，或病人腸胃道功能變化大時有其必要性。
92
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