低谷浓度和高谷浓度万古霉素疗效与安全性比较

Clinical Efficacy and Nephrotoxicity of High or Low Vancomycin Trough Concentration Therapy

目的:比较低谷浓度和高谷浓度万古霉素的疗效和安全性。方法:采用回顾性队列研究方法,回顾性收集2009～2011年135例成年患者的数据,依照平均谷浓度分为低浓度组(<15 mg.L-1)与高浓度组(≥15 mg.L-1),分别比较其临床失败率、细菌清除失败率、在院死亡率和肾毒性发生率。结果:135名患者中低浓度组与高浓度组人数分别为91例和44例。两组的临床失败率、细菌清除失败率、在院死亡率分别为37.4%vs 43.2%(校正比值比0.849)、37.4%vs 31.8%(校正比值比0.575)、7.7%vs 13.6%(校正比值比0.613),均没有显著差异,而高浓度组肾毒性发生率显著增加。结论:高谷浓度与低谷浓度万古霉素相比疗效没有显著性差异,但其肾毒性发生显著增加。

Objective： To examine the clinical outcomes of high or low vancomycin serum trough concentration in treated subjects. Methods： A retrospective cohort study evaluating 135 adults from 2009 to 2011 was conducted. Patients were stratified by mean vancomycin trough levels [low （〈15 mg·L ^-1）, high （≥15mg·L^-1））]. Outcomes were clinical failure, microbiological failure, in-hospital mortality and nephrotoxicity. Results： The 135 patients in the study were stratified into low （n=91） and high （n=44） groups. Clinical failure, microbiological failure and in-hospital mortality occurred in the low vs high groups, respectively, as 37.4% vs 43.2% （adjusted OR 0.849）, 37.4% vs 31.8% （adjusted OR 0.575） and 7.7% vs 13.6% （adjusted OR 0.613）. Nephrotoxicity rate was higher in the high trough level group. Conclusion： In conclusion, clinical efficacies were similar regardless the trough concentrations, while high trough levels may place patients at an increased risk of nephrotoxicity.