Systemic inflammation： a nonnegligible factor in precision pharmacotherapy

WANG Qian

doi:10.6039/j.issn.1001-0408.2026.20.01

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Systemic inflammation： a nonnegligible factor in precision pharmacotherapy

更新时间：2026-10-29

- Systemic inflammation： a nonnegligible factor in precision pharmacotherapy
- ZHONGGUO YAOFANG Vol. 37, Issue 20, Pages: 2621-2627(2026)
- 作者机构：
  
  陆军军医大学第一附属医院药剂科，重庆　400038
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2026.20.01
  CLC： R969.1;R969.3
- Received：17 October 2026，
  
  Revised：2026-10-08，
  
  Accepted：16 October 2026，
  
  Published：30 October 2026
- 稿件说明：
移动端阅览
.全身性炎症：不可忽视的精准用药影响因素[J].中国药房,2026,37(20):2621-2627.

WANG Qian.Systemic inflammation： a nonnegligible factor in precision pharmacotherapy[J].ZHONGGUO YAOFANG,2026,37(20):2621-2627.
.全身性炎症：不可忽视的精准用药影响因素[J].中国药房,2026,37(20):2621-2627. DOI： 10.6039/j.issn.1001-0408.2026.20.01.

WANG Qian.Systemic inflammation： a nonnegligible factor in precision pharmacotherapy[J].ZHONGGUO YAOFANG,2026,37(20):2621-2627. DOI： 10.6039/j.issn.1001-0408.2026.20.01.

摘要

全身性炎症常见于感染、肿瘤、应激、衰老等病理生理状态，是影响药物代谢的重要非遗传因素。炎症状态下，白细胞介素-6（IL-6）、肿瘤坏死因子α等炎症指标经核因子κB等通路抑制细胞色素P450（CYP450）酶系及药物转运体表达，改变血浆蛋白结合与组织分布，使药物体内暴露偏离基因型预测，出现临床药物代谢表型与基因型不一致的表型转化，从而影响基于基因型、靶点表达及生理参数制定个体化用药决策的精准性。细胞因子中，IL-6对CYP3A4、CYP2C19、CYP2C9、CYP2D6等酶及P-糖蛋白等转运体影响广泛，IL-6抑制剂可逆转其对CYP450酶的抑制作用。将炎症基线及其动态轨迹作为时变协变量纳入群体药代动力学模型，并结合治疗药物监测与人工智能技术，有望实现炎症指标驱动的精准给药。本文综述全身性炎症对药物代谢酶和转运体的影响及分子机制，分析将炎症指标纳入个体化用药评估的挑战与前景，提出应重视全身性炎症这一系统性变量，加强基础与临床研究，将炎症状态及动态轨迹融入用药决策，有助于提升个体化用药的精准性。

Abstract

ystemic inflammation， commonly observed in pathophysiological states such as infection， malignancy， stress， and aging， is an important non-genetic factor affecting drug metabolism. Under inflammatory conditions， inflammatory indicators such as interleukin-6 （IL-6） and tumor necrosis factor-α inhibit the expression of the cytochrome P450 （CYP450） enzyme system and drug transporters via pathways including nuclear factor-κB， and alter plasma protein binding and tissue distribution， causing

in vivo

drug exposure to deviate from genotype-based predictions and leading to phenoconversion， which is a discordance between the clinical drug-metabolizing phenotype and the drug-metabolizing genotype. This affects the precision of personalized medication decisions based on genotype， target expression， and physiological parameters. Among cytokines， IL-6 broadly affects enzymes such as CYP3A4， CYP2C19， CYP2C9， and CYP2D6 and transporters such as P-glycoprotein， while IL-6 inhibitors can reverse its inhibitory effects on CYP450 enzymes. Incorporating baseline inflammatory status and its dynamic trajectory as time-varying covariates into population pharmacokinetic models， in combination with therapeutic

drug monitoring and artificial intelligence， is expected to enable inflammation-driven precision dosing. This article reviews the effects and molecular mechanisms of systemic inflammation on drug-metabolizing enzymes and transporters， analyzes the challenges and prospects of integrating inflammatory indicators into personalized pharmacotherapy assessment， and proposes that systemic inflammation， as a systemic variable， should be emphasized， with basic and clinical research strengthened and inflammatory status and its dynamic trajectory incorporated into medication decision-making， which may improve the precision of personalized pharmacotherapy.

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references

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