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  • 李燕,王学彬,陈礼治,杨云云,沈林娟,王卓*.万古霉素血药浓度与临床疗效及急性肾损伤的关系[J].第二军医大学学报,2021,42(3):281-286    [点击复制]
  • LI Yan,WANG Xue-bin,CHEN Li-zhi,YANG Yun-yun,SHEN Lin-juan,WANG Zhuo*.Association of blood vancomycin level with its clinical efficacy with acute kidney injury[J].Acad J Sec Mil Med Univ,2021,42(3):281-286   [点击复制]
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万古霉素血药浓度与临床疗效及急性肾损伤的关系
李燕,王学彬,陈礼治,杨云云,沈林娟,王卓*
0
(海军军医大学(第二军医大学)长海医院药学部, 上海 200433
*通信作者)
摘要:
目的 探讨万古霉素稳态谷浓度(Cmin)和峰浓度(Cpeak)与临床疗效及急性肾损伤(AKI)的关系。方法 回顾性纳入2015年11月至2019年4月于海军军医大学(第二军医大学)长海医院住院、住院期间使用万古霉素且至少测定了1次万古霉素Cmin或 Cpeak的136例患者作为研究对象,收集患者的基本信息及相关指标。万古霉素Cmin和Cpeak均取达稳态后首次测定值,根据Cmin值将患者分为<10、10~15、>15 mg/L组,根据Cpeak值分为<25、25~40、>40 mg/L组。探究万古霉素Cmin和Cpeak与临床疗效及AKI的相关性。结果 共134例患者参与万古霉素Cmin与临床疗效及AKI的关系评价,Cmin<10、10~15、>15 mg/L组分别为78、21、35例,总有效率为76.9%(103/134),各组间有效率差异无统计学意义(P=0.092);AKI总发生率为15.7%(21/134),Cmin>15 mg/L组AKI发生率(34.3%,12/35)高于<10 mg/L组(6.4%,5/78),差异有统计学意义(P=0.001)。共105例患者参与万古霉素Cpeak与临床疗效及AKI的关系评价,Cpeak<25、25~40、>40 mg/L组分别为53、44、8例,总有效率为79.0%(83/105),各组间有效率差异无统计学意义(P=0.758);AKI总发生率为16.2%(17/105),Cpeak>40 mg/L组AKI发生率(62.5%,5/8)高于<25 mg/L组(7.5%,4/53),差异有统计学意义(P=0.008)。结论 万古霉素血药浓度的高低与临床疗效未见明显相关性,但血药浓度高者AKI发生率较高。
关键词:  万古霉素  药物监测  治疗结果  急性肾损伤
DOI:10.16781/j.0258-879x.2021.03.0281
投稿时间:2020-09-04修订日期:2021-01-04
基金项目:
Association of blood vancomycin level with its clinical efficacy with acute kidney injury
LI Yan,WANG Xue-bin,CHEN Li-zhi,YANG Yun-yun,SHEN Lin-juan,WANG Zhuo*
(Department of Pharmacy, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author)
Abstract:
Objective To investigate the association of trough concentration (Cmin) and peak concentration (Cpeak) of vancomycin in steady state with its clinical efficacy and acute kidney injury (AKI). Methods A total of 136 patients who were hospitalized in Changhai Hospital of Naval Medical University (Second Military Medical University) from Nov. 2015 to Apr. 2019 and who received vancomycin therapy (the Cmin or Cpeak was determined at least once) during hospitalization were retrospectively included. The basic information and related indicators of patients were collected. Both Cmin and Cpeak of vancomycin were determined for the first time after reaching steady state. According to the Cmin, they were divided into <10, 10-15 and >15 mg/L groups; according to the Cpeak, they were divided into <25, 25-40 and >40 mg/L groups. The correlations of Cmin and Cpeak with clinical efficacy and AKI were explored. Results The relationship of Cmin with clinical efficacy and AKI was evaluated in 134 cases, with 78, 21 and 35 cases in Cmin<10, 10-15 and >15 mg/L groups, respectively. The total effective rate was 76.9% (103/134), and there was no significant difference in the effective rate among all groups (P=0.092). The total incidence of AKI was 15.7% (21/134), and Cmin >15 mg/L group had a significantly higher incidence of AKI than <10 mg/L group (34.3%[12/35] vs 6.4%[5/78], P=0.001). The relationship of Cpeak with clinical efficacy and AKI was evaluated in 105 cases, with 53, 44 and 8 cases in <25, 25-40 and >40 mg/L groups, respectively. The total effective rate was 79.0% (83/105), and there was no significant difference among all groups (P=0.758). The total incidence of AKI was 16.2% (17/105), and Cpeak >40 mg/L group had a significantly higher incidence of AKI than <25 mg/L group (62.5%[5/8]vs 7.5%[4/53], P=0.008). Conclusion There is no significant correlation between blood vancomycin level and clinical efficacy, but the incidence of AKI is higher in patients with high blood vancomycin level.
Key words:  vancomycin  drug monitoring  treatment outcome  acute kidney injury