重症感染肿瘤患者使用万古霉素致相关肾功能不全的危险因素分析

Analysis of risk factors associated with vancomycin induced renal insufficiency in severe infection patients with cancer

目的:统计分析肿瘤患者使用万古霉素治疗重症感染致肾功能不全的发生率及相关危险因素。方法:回顾我院24个月共87例入住重症监护病房的重症感染肿瘤患者使用万古霉素的病历,采集包括合并慢性疾病情况、合并肾毒性药物情况、用药前肿瘤治疗情况(是否手术、放疗、化疗)及急性生理与慢性健康评分(APACHE-Ⅱ评分)等数据,详细记录万古霉素的剂量、疗程及用药前后血肌酐水平等。使用SPSS 21.0统计学软件,进行单变量及多变量分析(χ2检验,P<0.05定义为差异有统计学意义)。结果:纳入病例中57例(65.5%)患者APACHE-Ⅱ评分在15分以上,24例(27.6%)患者合并慢性疾病(高血压、糖尿病、慢性阻塞性肺疾病等),34例(39.1%)患者万古霉素使用疗程在7 d以上,50例(57.5%)患者用药前30 d内行手术治疗,13例(14.9%)患者用药前30 d内行放射治疗,23例(26.4%)患者用药前30 d内行肿瘤化疗。18例(20.7%)患者在使用万古霉素后至停药14 d内出现不同程度的肾功能不全。单变量分析显示年龄、性别、合并慢性疾病情况、药物使用疗程、用药前手术、放疗、用药前血肌酐水平及合用潜在肾毒性药物情况对用药后肾功能不全的发生无显著影响。APACHE-Ⅱ评分、用药前30 d内行肿瘤化疗对用药后肾功能不全发生率有显著影响(P=0.034、P=0.011)。结论:APACHE-Ⅱ评分较高及用药前30 d曾行化疗的肿瘤患者在发生重症感染使用万古霉素时发生肾功能不全的风险增加,应特别注意。

OBJECTIVE To investigate risk factors associated with vancomycin induced renal insufficiency in severe patients with cancer and record the incidence.METHODS A total of 87 patients enrolled in24 months period were reviewed retrospectively.Chronic diseases,nephrotoxicity drug combination,oncotherapy before vancomycin（surgery,radiotherapy or chemotherapy）,acute physiology and chronic health evaluation score（APACHE-Ⅱ）were systematically retrieved from original patient files and detailed records of vancomycin dose,course of treatment,serum creatinine before and after vancomycin therapy.Univariate analysis and multivariate analysis were performed using Pearsonχ2 test.RESULTS A total of 57 patients（65.5%）had APACHE-Ⅱ scores above 15 points,24 patients（27.6%）concurrently had chronic diseases（hypertension,diabetes,chronic obstructive pulmonary diseases,etc.）,34 patients（39.1%）used vancomycin for more than 7 days.In the past 30 days,50 patients（57.5%）received surgery,13 patients（14.9%）received radiotherapy and 23 patients（26.4%）received chemotherapy.Renal insufficiency occurred in 18 patients（20.7%）during or 14 days after therapy.In univariate analysis,age,gender,chronic diseases,course of treatment,surgery,radiotherapy,serum creatinine and nephrotoxicity drug combination were not significantly correlated with renal insufficiency.APACHE-Ⅱ scores and chemotherapy within 30 days before vancomycin were related with renal insufficiency（P=0.034,P=0.011）.CONCLUSION Risk of renal insufficiency will increase when vancomycin is used in severely infected cancer patients with high APACHE-Ⅱ scores or received chemotherapy.