万古霉素群体药代动力学模型在临床应用中的预测性能的评估

Evaluation of the predictive performance for a vancomycin population pharmacokinetic model

目的评估万古霉素群体药代动力学(PPK)模型在临床应用中的预测性能。方法收集广西医科大学第一附属医院静脉应用万古霉素治疗的成人住院患者,根据万古霉素PPK模型,通过贝叶斯反馈法求出给定剂量下的稳态谷浓度和稳态峰浓度个体预测值,与实测值比较,评估模型的预测效能。结果共纳入271例患者697个血药浓度值,其中稳态谷浓度417个,稳态峰浓度280个。谷浓度和个体预测值均值分别为(11.85±7.14)和(11.08±6.81)mg·L^(-1),峰浓度和个体预测值均值分别为(18.42±9.61)和(17.61±7.37)mg·L^(-1)。谷浓度的平均预测误差、平均相对预测误差、平均绝对误差和均方根误差分别为-0.77 mg·L^(-1),-2.53%,1.63 mg·L^(-1)和2.38 mg·L^(-1),峰浓度的平均预测误差、平均相对预测误差、平均绝对误差和均方根误差分别为-0.81 mg·L^(-1),1.53%,2.28 mg·L^(-1)和3.32 mg·L^(-1),相对预测误差在±30%以内的血药浓度值约占92%。结论建立的万古霉素PPK模型在临床应用中具有较高的预测性能,可用于指导万古霉素的个体化给药。

Objective To evaluate comycin population pharmacokinetic the predictive performance of a van- （PPK） model in clinical application. Methods Aduh inpatients who received intravenous vancomycin treatment were collected in the First Affiliated Hospital of Guangxi Medical University. Individual predictive values （IPRED） of steady - state trough concentrations （ Ctrough ） and peak concentrations （ Cpeak ） at a given dose were estimated by bayesian feedback method basing on a PPK model. The predictive performance was evaluated by comparing the IPRED with the measured values. Results A total of 271 patients with 697 samples were included ,including 417 Ctrough and 280 Cpeak. The mean Ctrough and its mean IPRED were （11.85 ± 7.14） and （11.08 ±6.81 ）mg·L-1 ; the mean Cpeak and its mean IPRED were （18.42 ±9.61 ） and （17.61 ±7.37）mg·L-1. The mean error, mean relative error, mean absolute error and root mean square error were - 0. 77 mg·L-1, -2.53%, 1.63mg·L-1 and 2.38mg·L-1 for Ctrough, and -0.81mg·L-1, 1.53% , 2. 28 mg·L-1 and 3.32mg·L-1 for Cpeak, respectively. About 92% of the concentrations had a relative error within ± 30%. Conclusion Previously established vancomycin PPK model has an excellent predictive performance in the clinical application, which is useful for individualized administration of vancomycin in adult patients.