万古霉素治疗细菌性肺炎患者时血药谷浓度与肾毒性相关性研究

Nephrotoxicity and serum trough concentration of vancomycin in patients with bacterial pneumonia

目的观察细菌性肺炎患者万古霉素谷浓度〉10mg·L^-1时肾毒性的发生。方法将53例万古霉素谷浓度〉10mg·L^-1的患者按谷浓度不同分为A（谷浓度〉15mg·L^-1）、B（10mg·L^-1〈谷浓度≤15mg·L^-1）2组，治疗前至治疗后3d内进行肾功能指标的监测。结果53例患者中共有5例（9．4％）发生肾毒性，其中A组（25例）发生4例（16．0％），B组（28例）发生1例（3．6％）；与用药前相比，A组患者用药后血肌酐值有明显上升（P=0．006），内生肌酐清除率有明显下降（P=0．014），B组患者用药前后上述指标无明显变化（P=0．276，P=0．750）；2组间用药前后内生肌酐清除率的差值具有统计学意义（P=0．044）；A组患者谷浓度与内生肌酐清除率及血肌酐值的变化均有线性相关（P=0．005，Pearson相关系数为-0．648；P=0．001，Pearson相关系数为0．716）。结论当万古霉素谷浓度在10～15mg·L^-1时，对肾功能的影响较小；而谷浓度超过15mg·L^-1时，肾功能有明显下降。

Objective To evaluate vancomycin-associated nephrotoxicity when vancomycin serum trough concentration exceeds 10 mg·L^-1. Methods A total of 53 patients were divided into group A （serum trough concentration〉15 mg ·L^-1 ） and group t3 （10 mg ·L^-1〈serum trough concentration ≤ 15 mg·L^-1 ）. Renal function was determined before and 3 days after vancomycin medication. Results Five out of the 53 patients developed nephrotoxicity （9.4%）, 4 in group A （16.0%） and 1 in group B （3.6%）. Compared with before the medication, serum creatinine concentration was markedly increased （P=0. 006） and endogenous creatinine clearance rate was significantly decreased （P=0.014） in group A. No significant difference was observed in group B （P=0. 276 P=0. 750）. There were significant differences between the two groups of endogenous creatinine clearance rate before and after the medication. There was correlation of the trough concentration and changes of serum creatinine concentration and endogenous creatinine clearance rate in group A （P=0. 005, Pearson correlation coeffient =-0.648; P=0. 001, Pearson correlation coeffient =0. 716 ）. Conclusion The influence of vancomycin serum trough concentration on renal function is limited when it is at 10 mg ·L^-1 to 15mg ·L^-1, but the renal function could significantly deteriorate when vancomycin serum trough concentration is above 15 mg ·L^-1