肾功能亢进患者万古霉素血药浓度监测与临床疗效分析

Analysis of therapeutic drug monitoring and clinical efficacy of vancomycin in patients with augmented renal clearance

目的:调查分析肾功能亢进(augmented renal clearance,ARC)患者使用万古霉素的用药剂量、谷浓度及临床疗效。方法:回顾性研究2013年7月-2017年3月在某院住院期间使用过万古霉素并进行了血药浓度监测的67例ARC患者和142例肾功能正常患者病历资料,比较2组万古霉素给药方案、谷浓度及临床疗效。结果:ARC组与肾功能正常组初始给药的日剂量分别为(2.0±0.3)g和(1.8±0.4)g,具有显著性差异(P=0.041)。ARC组初始给药方案下谷浓度均值(8.3±5.2)mg·L^(-1)明显低于肾功能正常组的谷浓度均值(14.3±8.4)mg·L^(-1),有显著性差异(P=0.000)。ARC患者的初始给药方案谷浓度达标率为20.6%,肾功能正常组为40.1%,具有显著性差异(P=0.007)。ARC组万古霉素的临床总有效率和革兰阳性菌清除率分别为69.1%和67.6%,肾功能正常组为76.7%和81.6%,均无显著性差异(P=0.286;P=0.143)。结论:多数ARC患者初始方案万古霉素用药剂量不足,谷浓度达标率较肾功能正常患者更低。

OBJECTIVE To analyze the dosage regimen,trough concentration and clinical effect of vancomycin treatment in patients with augmented renal clearance（ ARC）. METHODS This retrospective study recorded the clinical data of adult inpatients treated with vancomycin and had therapeutic drug monitored from July 2013 to March 2017 in a Hospital,involving 67 cases of ARC and142 cases of normal renal function. The dosage regimen,trough concentration and clinical effect were compared between ARC and normal renal function groups. RESULTS The daily doses of vancomycin in initial dosage regimen were（2. 0 ± 0. 3） g and（1. 8 ± 0. 4）g in ARC and normal renal function groups（ P = 0. 041）. Trough concentration of initial dosage regimen in ARC group was much lower than that of normal renal function group [（8. 3 ± 5. 2） mg·L^-1 vs.（14. 3 ± 8. 4） mg·L^-1,P = 0. 000）]. The rate of the high trough concentration standards was only 20. 6%,with statistical difference when compared to normal renal function group（ 20. 6% vs.40. 1%,P = 0. 007）. The clinical total effective rate and bacterial clearance rate had no statistical difference between ARC and normal renal function groups（69. 1% vs. 76. 7%,P = 0. 286; 67. 6% vs. 81. 6%,P = 0. 143）. CONCLUSION The daily doses of initial and adjusted dosage regimens of most ARC patients in a hospital were inadequate,and most trough concentrations were below 10-20 mg·L^-1.