老年人群万古霉素治疗药物监测的系统评价

A Systemic Review of Therapeutic Drug Monitoring of Vancomycin in Elderly People

目的:系统评价万古霉素治疗药物监测在老年人群较年轻人群的必要性。方法:系统检索Pub Med、Embase、the Cochrane Library和中文数据库CNKI、Wan Fang、CBM,检索时限均从建库至2014年1月。纳入老年人群使用万古霉素的临床研究。按纳入和排除标准筛选文献、提取资料并评价研究质量。结果:共纳入4篇队列研究,显示老年人群较年轻人群使用万古霉素时肾毒性有增加趋势,其中1篇研究显示老年人群使用万古霉素致肾毒性发生率较年轻人群的差异有统计学意义(P<0.05)。结论:万古霉素所致的肾毒性在老年人群中有增加趋势,需要提高对万古霉素治疗药物监测的关注;但由于纳入研究数量和质量的限制,上述结论尚需进一步开展更多高质量、大样本的临床研究加以验证。

Objective：To systematic evaluate the necessity of vancomycin therapeutic drug monitoring in elderly people compared with younger people. Methods：Electronic databases such as PubMed, Embase, the Cochrane library and Chinese database （CNKI, WanFang, CBM） were searched from establishment dates of databases to January 2014. The clinical observational studies which include elderly people using vancomyein intravenously was identified. The studies were screened according to the inclusion and exclusion criteria, the data were extracted, the quality of the included studies was assessed. Results： Four cohort studies were identified. The tendency of vancomycin induced nephrotoxicity was increased in elderly people compared with younger people. And one study showed that differences of incidence of vancomycin induced nephrotoxieity between in elderly people and younger people were statistically significant （ P 〈 0.05 ）. Conclusion： The tendency of vancomycin induced nephrotoxicity was increased in elderly people, so we should pay attention to monitor the concentration of vancomycin in elderly people. However, due to the low methodological quality of the included studies, more high-quality and large-scale clinical studies needed to be conducted to verify this conclusion.