用血清胱抑素C水平尝试推算万古霉素的安全有效剂量

Using serum cystatin clevels try to estimate the safe and effective dose of vancomycin

目的探讨用血清胱抑素C水平估算万古霉素治疗MRSA感染者的日给药方案。方法检测36例MRSA感染者Van、CysC和血、尿肌酐浓度,估算所有患者的eGFR、CLcr和CLvan,并通过数理方法尝试拟合了CysC与CLvan的相关方程,再通过药动学理论转化为估算用Van治疗的日给药等式。结果 eGFR和CLcr之间存在相关关系(R2=0.6751,P=0.000),经Bland-Altman分析表明两者间一致性高达97.2%(35/36)。eGFR和CLvan之间存在相关关系(R2=0.8533,P=0.000)。用CysC能拟合相关度很高的CLvan估计方程(R2=0.9063,P=0.000):CLvan=138.583-73.336CysC+16.045CysC2-1.306CysC3,并根据该方程衍生出用CysC推算达到某一目标浓度(Css)时Van的每日剂量等式:IR(g·d-1)=(138.583-73.336CysC+16.045CysC2-1.306CysC3)×Css(mg·L-1)×(60/1000)×24。结论对估计Van剂量,CysC是更加优于肌酐的肾功能标记物;用CysC按Van的药代动力学理论,可简单、快速的估计其每日剂量。

Objective To investigate the daily dosage regimen of vancomycin treating patients with MRSA infectioned using serum cystatin C. Methods Van, CysC and serum and urine creatinine concentrations were detected in 36 MRSA infected patients, and estimated eGFR, CLcr and CLvan,then try to fit the correlation equation between CysC and CLvan using mathematical methods. Finally,the daily administration formula of Van was derivated according to pharmacokinetic theory. Results There were a significant correlation between eGFR and CLcr（R2=0.6751,P=0.000）.Bland-Altman analysis showed agreement up to 97.2%（35/36）between eGFR and CLcr.eGFR was strongly correlated with CLvan（R2=0.8533,P=0.000）.Using CysC can fit a high correlation CLvan estimating equation（R2=0.906 3,P=0.000）：CLvan=138.583-73.336CysC＋16.045 CysC2-1.306CysC3.Accordingly,the predicted formula was created for calculation of the dose of vancomycin needed as a function of the CysC estimates to achieve the appropriate target Css：IR（g·d-1）=（138.583- 73.336 CysC＋16.045 CysC2-1.306CysC3）× Css（mg·L-1）×（60/1 000）×24. Conclusion Serum cystatin C was a good marker of renal function in comparison with serum creatinine for dose setting of vancomycin. According to pharmacokinetic theorycan,using CysC can simple,quick estimate the daily dose of vancomycin.