克林霉素静脉滴注给药致急性肾损伤的危险因素分析

Risk factors for acute kidney injury induced by intravenous infusion of clindamycin

目的:对克林霉素静脉滴注致急性肾损伤(AKI)的危险因素进行分析,为临床安全用药提供参考。方法:回顾性分析2014年10月-2017年10月某院71例克林霉素致AKI和同期使用克林霉素但未发生AKI的582例患者的临床资料,采用单因素(t检验或χ2检验)及多因素(Logistic回归)对肾毒性危险因素进行分析。结果:AKI是克林霉素严重不良反应之一,发生率为10.87%。单因素分析显示,用药前血肌酐、肌酐清除率、入住ICU、合并严重心功能不全或呼吸衰竭、联合利尿剂或质子泵抑制剂、给药浓度和用药疗程与克林霉素肾毒性相关。多因素分析显示,入住ICU、给药浓度、联用质子泵抑制剂或利尿剂、基线肌酐清除率是克林霉素引起AKI的独立危险因素。大部分AKI患者转归较好,无继发严重肾功能衰竭或尿毒症患者。结论:临床实践中应重点关注有独立危险因素的患者,以保证克林霉素临床安全用药。

OBJECTIVE To investigate the risk factors of acute kidney injury（AKI）induced by clindamycin for intravenous infusion,provide a reference for clinical safety medication.METHODS The 71 patients with AKI induced by clindamycin for intravenous infusion and582 patients treated with clindamycin but not demonstrated AKI from October 2014 to October 2017 in our hospital were respectively analyzed.Single factor（t test orχ^2 test）and multiple factors（logistic regression）were used to select risk factors related to AKI.RESULTS AKI was one of the serious ADRs of clindamycin with an incidence of 10.87%in this investigation.According to single factor analysis,factors associated with nephrotoxicity were serum creatinine,creatinine clearance rate,ICU residence,severe heart failure or respiratory failure,combined diuretic or proton pump inhibitors,infusion concentration and course of treatment with clindamycin.And multivariate analysis identified independent factors including ICU residence,infusion concentration of clindamycin,combined diuretic or proton pump inhibitors,creatinine clearance rate.Most of the patients with AKI had better outcome,no secondary serious renal failure or uremia.CONCLUSION Clinical practice should focus on patients with independent risk factors to ensure safe clinical use of clindamycin.