万古霉素血药浓度与肾功能指标间的关系

Relationship between blood concentration of Vancomycin and renal function indicators

目的探讨静脉应用万古霉素后首次测定万古霉素谷浓度时的肾功能变化情况,评估万古霉素血药浓度与肾功能指标的相关性。方法收集2015年1月~2017年12月在解放军第904医院(原101医院)神经重症监护室住院的61例重度脑损伤合并革兰阳性(G+)球菌肺炎患者,测定万古霉素用药前及用药48 h后的血生化指标,包括尿素氮(BUN)、血肌酐(SCr)、β2微球蛋白(β2-MG)、α1微球蛋白(α1-MG)、胱抑素C(Cys-C),采用MDRD计算肾小球滤过率(eGFR)及万古霉素谷浓度。对用药前后的肾功能指标进行统计学分析,采用多元相关分析和多元线性回归分析对万古霉素血药浓度及肾功能指标的相关性进行分析。结果用药后的β2-MG、Cys-C水平高于用药前,差异有统计学意义(P<0.05);用药前后的BUN、SCr、α1-MG水平比较,差异无统计学意义(P>0.05);用药后的eGFR水平低于用药前,差异有统计学意义(P<0.05)。万古霉素血药浓度与BUN、SCr、β2-MG及Cys-C水平成正相关(r=0.468、0.612、0.733、0.751,P<0.05),与eGFR水平成负相关(r=-0.575,P<0.05),与α1-MG水平无相关性(P>0.05)。结论应用万古霉素48 h后即可出现血β2-MG、Cys-C等指标的明显增高及eGFR水平降低,提示β2-MG、Cys-C、eGFR是早期敏感指标。万古霉素血药浓度与BUN、SCr、β2-MG、Cys-C水平成正相关,与eGFR水平成负相关。

Objective To explore the changes of renal function when the Vancomycin at a minimum concentration(Cmin)was first detected after intravenous administration of vancomycin,and to evaluate the correlation between blood concentration of Vancomycin and renal function indicators.Methods A total of 61 patients with severe brain injury and Gram-positive cocci(G+)pneumonia hospitalized in the Neuro-Intensive Care Unit of the 904th Hospital of the PLA(formerly 101 Hospital)from January 2015 to December 2017 were selected.The biochemical indicators including blood urea nitrogen(BUN),serum creatinine(SCr),β2 microglobulin(β2-MG),α1 microglobulin(α1-MG),cystatin C(Cys-C)before Vancomycin and 48 hours after medication were tested.The estimated glomerular filtration rate(eGFR)and Vancomycin concentration were calculated using Modification of Diet in Renal Disease.Statistical analysis was performed on the renal function indicators before and after medication,and the correlation between Vancomycin plasma concentration and renal function indicators was analyzed using multiple correlation analysis and multiple linear regression analysis.Results After treatment,the levels ofβ2-MG and Cys-C were higher than those before treatment,and the differences were statistically significant(P<0.05).There were no statistical differences in the levels of BUN,SCr,andα1-MG before and after treatment(P>0.05).After treatment,the eGFR level was lower than that before treatment,and the difference was statistically significant(P<0.05).The blood concentration of Vancomycin was positively correlated with the levels of BUN,SCr,β2-MG and Cys-C(r=0.468,0.612,0.733,0.751,P<0.05),negatively correlated with the level of eGFR(r=-0.575,P<0.05),and not correlated with the level ofα1-MG(P>0.05).Conclusion Forty-eight hours after using Vancomycin,indicators such asβ2-MG and Cys-C increases significantly and eGFR decreases,suggesting thatβ2-MG,Cys-C,and eGFR are early sensitive indicators.The blood concentration of Vancomycin is positively correlated with the levels of BUN,SCr,β2-MG,and Cys-C,and negatively correlated with the level of eGFR.