肾功能与联合用药对地高辛血药浓度影响的回顾性分析

Retrospective Study on Effects of Renal Function and Combined Medication on Serum Concentration of Digoxin

目的分析肾功能与联合用药对地高辛血药浓度的影响,为临床合理用药提供参考依据。方法以我院2013年1月~2016年1月心内科收治的482例长期服用地高辛的患者为研究对象,对其临床诊治资料进行回顾性分析。患者按照其肾小球滤过率(GFR)分为肾功能损伤组、肾功能正常组,比较两组患者地高辛血药浓度差异,并比较不同地高辛血药浓度患者联合用药情况,总结肾功能、联合用药等因素对患者地高辛血药浓度的影响。结果肾功能损伤组地高辛血药浓度显著高于肾功能正常组,差异有统计学意义(P<0.05)。Spearman相关性分析示,患者GFR与地高辛血药浓度呈显著负相关(r=-0.833,P<0.05)。GFR<60 m L·min^(-1)·1.73 m^(-2)、年龄≥60岁、使用β-受体阻滞剂、使用噻嗪类利尿剂、使用抗菌药物是影响地高辛血药浓度的危险因素,使用抗凝剂为地高辛血药浓度的保护因素,差异有统计学意义(P<0.05)。结论地高辛血药浓度受肾功能与联合用药影响明显,结合患者肾功能和联合用药情况优化治疗方案很有必要。

Objective To analyze the effect of renal function and combined use of drugs on serum digoxin concentration, so as to provide reference for clinical rational drug use. Methods 482 patients were subjects for study, who had been treated with digoxin in the department of cardiology of our hospital during January 2013 to January 2016, a retrospective analysis about the clinical data of all patients was carried out. All patients were divided into renal function injury group and normal renal function group according to the glomerular filtration rate. The blood drug concentrations of digoxin in different groups were compared,at the same time, the drug combination of the patients with different serum concentrations of digoxin were compared, in order to investigate the influence of renal function and drug combination on the concentrations of digoxin. Results The concentration of digaoxin in renal function injury group was higher than the normal renal function group, and the difference was statistically significant (P < 0.05). The results of spearman correlation analysis showed that, the GFR had significantly negative correlation with serum digoxin concentration (r=-0.833, P < 0.05). GFR < 60 mL·min-1·1.73 m-2, age ≥ 60 years, taking beta blockers,taking thiazide diuretics, and the use of antimicrobial drugs were the risk factors affecting the serum digoxin concentration, but the use of anticoagulants was a protective factor of digoxin concentration, and had statistically significance (P < 0.05). Conclusion Serum concentration of digoxin is significantly influenced by renal function and drug combination, considering the patient’s renal function and drug combination to optimize the treatment program is very necessary.