儿童万古霉素血药浓度影响因素分析

Analysis of Influential Factors for Vancomycin Blood Concentration of Children

目的研究儿童万古霉素血药谷浓度的影响因素,为临床应用提供参考。方法采用回顾性研究方法,收集某院2013年8月1日～2016年11月30日选择万古霉素治疗并监测其血药谷浓度的患者共58例,分析其稳态万古霉素血药谷浓度的分布情况,并采用单因素回归分析和多重线性回归(逐步回归)方法分析胱抑素C、血清肌酐及其他因素与万古霉素血药谷浓度相关性。结果 58例万古霉素血药谷浓度监测结果中,达到目标治疗窗10～20μg·m L^(-1)为19例(32.76%)。单因素分析中可能影响万古霉素浓度的因素有胱抑素C、血清肌酐和是否有先天性心脏病;而多重线性回归分析中,仅保留了胱抑素和先天性心脏病两个因素。结论儿童万古霉素血药谷浓度个体差异大,胱抑素C,血清肌酐及是否先天性心脏病与儿童万古霉素血药谷浓度有明显相关性,如何预测儿童万古霉素谷浓度有待进一步研究。

OBJECTIVE To study factors that may affect vancomycin blood concentration of children,and to provide reference for clinical use of vancomycin. METHODS A retrospective study was conducted to analyze vancomycin trough concentrations of 58 pediatric patients from August 1 st 2013 to November 30 th 2016,to analyze the distribution vancomycin concentrations,and univariate analysis as well as multiple linear regression method in a stepwise manner was used to analyze the relationship between vancomycin trough concentration and Cys C,Scr and other factors. RESULTS Within 58 cases,only vancomycin plasma concentration of 19 cases( 32.76%) reached the 10-20 μg·m L^-1 target concentration.By the univariate analysis,we found the factors included Cys C,Scr and patients with congenital heart disease affected the concentration of vancomycin concentration.But the multiple linear regression only included Cys C,and patients with congenital heart disease as independent variables. CONCLUSION There is a high individual difference of vancomycin trough concentration among children.Cys C,Scr and congenital heart disease were correlated to concentration vancomycin trough concentration of children.Further study should be conducted to use these influential factor to predict the concentration vancomycin trough concentration of children.