万古霉素与去甲万古霉素对老年感染患者的肾毒性比较

Comparison of the nephrotoxicity of vancomycin and norvancomycin on elderly patients

目的比较万古霉素与去甲万古霉素对老年感染患者的肾毒性。方法纳入天津市西青医院2013年3月～2014年10月收治的因感染住院的老年患者105例。随机分为2组,一组52例,使用万古霉素进行抗感染治疗;另一组53例,使用去甲万古霉素进行抗感染治疗,均治疗2 w。观察患者体内血清尿素氮、肌酐水平变化和不良反应情况。结果万古霉素组患者用药10 d后和停药7 d后肌酐水平分别为（97.86±8.27）μmo I/L、（82.03±5.72）μmo I/L,和去甲万古霉素组[（98.67±8.34）μmo I/L、（83.47±5.91）μmo I/L]相比,差异无统计学意义。万古霉素组患者用药10 d后和停药7 d后尿素氮水平分别为（6.71±1.15）mmo I/L、（6.09±1.09）mmo I/L,和去甲万古霉素组[（6.75±1.17）mmo I/L、（6.15±1.12）mmo I/L]相比,差异无统计学意义。万古霉素组患者治疗后总有效率为78.85%,和去甲万古霉素组的75.47%相比,差异无统计学意义。万古霉素组患者治疗过程中不良反应比例为13.46%,和去甲万古霉素组13.21%相比,差异无统计学意义。结论万古霉素与去甲万古霉素抗感染疗效相当,治疗过程中2者均对患者的肾功能有一定影响,患者尿素氮、肌酐水平短暂升高,但停药后即恢复,2者的不良反应均较轻且无差异。

Objective To observe vancomycin and vancomycin in elderly patients with renal toxicity. Methods 105 cases because of infection from March 2013 to October 2014 were collected and randomly divided into two groups,one had 52 patients and were given vancomycin for anti-infection treatment,another group had 53 patients and were given norvancomycin for anti-infective treatment. Changes of serum urea nitrogen and creatinine levels and adverse reactions were observed and compared between two groups. Results Creatinine levels of patients with vancomycin group after 10 days and 7days after withdrawal were（ 97. 86 ± 8. 27） μmo I / L,（ 82. 03 ± 5. 72） μmo I / L,and the norvancomycin group were（ 98. 67 ± 8. 34） μmo I / L,（ 83. 47 ±5. 91） μmo I / L,the difference were not significant. Urea nitrogen levels of patients with vancomycin group after 10 days and 7 days after withdrawal were（ 6. 71 ± 1. 15） mmo I/L,（ 6. 09 ± 1. 09） mmo I/L,respectively,and the norvancomycin group were（ 6. 75 ± 1. 17） mmo I/L,（ 6. 15 ± 1. 12） mmo I/L,the difference were not statistically significant. The total effective rate of vancomycin group was 78. 85%,and norvancomycin group was 75. 47%,the difference was not statistically significant. Adverse reactions of vancomycin group during treatment was 13. 46%,and norvancomycin group was 13. 21%,the difference was not statistically significant. Conclusion Vancomycin and norvancomycinboth have anti-infective effect on renal function in patients with certain adverse effects,urea nitrogen,creatinine levels in two groups were elevated during treatment,but decreased after withdrawing medicine.