基于K-core算法回顾性分析真实世界中多黏菌素B对肾功能的影响

Retrospectively Analysis of the Effect of Polymyxin B on Renal Function Based on K-core Algorithm in the Real World

目的:基于K-core算法考察多黏菌素B用法用量对肾功能的影响,以此为临床安全合理使用多粘菌素B提供依据。方法:设置纳排标准,纳入南昌大学第一附属医院HIS电子病历系统2020年1月至12月使用多粘菌素B的165例病历,收集患者多黏菌素B用法用量、用药疗程,肌酐和尿素数值。在Gephi中开展复杂网络分析,以多黏菌素B使用天数作为源靶点(Source),以多黏菌素B用法用量作为作用靶点(Target),以患者用药前和使用天数之后复查的肌酐或尿素分别做weight信息,构建无向网络,计算布局格式和网络的平均度、网络直径、图密度、模块化、平均聚类系数、平均路径长度拓扑等参数,并基于K-core算法和度范围,提取权重较大的子群网络,评估多黏菌素B用法用量、用药疗程与肌酐及尿素间的权重关联。结果:165例使用多黏菌素B的病人中,有96例肌酐升高(58.18%),达到急性肾损伤标准的是58例(35.15%),急性肾损伤中有20例合并有尿素升高,提示多黏菌素B对患者肾功能的影响较大。构建多粘菌素B用法用量、疗程与肌酐或尿素关联的网络图,其中50 WU/次,2次/d;75 WU/次,2次/d;首次给药100 WU,后改为75 WU/次,2次/d;首次给药100 WU,后改为50 WU/次,2次/d四个用法用量对肌酐值或尿素的波动较大。联合雾化方式对肌酐值影响较小,负荷剂量100 WU,单次给药用法对肾功能影响较大。结论:临床上使用多粘菌素B对肾功能产生的影响较大,相当部分比例为急性肾损伤;100 WU负荷剂量多粘菌素B对肾功能影响较大,临床使用时应注意其不良反应。

Objective:The effect of dosage and usage of polymyxin B on renal function was inuestigated based on K-core,algorithm,so as to provide a basis for clinical safe and reasonable used of polymyxin B.Methods:165 cases of HIS electronic medical record system from January to December 2020 of The First Affiliated Hospital of Nanchang University were collected according to the inclusion criteria.The usage and dosage of polymyxin B,course of treatment,creatinine and urea values were collected.The complex network analysis was carried out in Gephi.The use days of polymyxin B were applied as the source,the usage of polymyxin B was applied as the target,while creatinine or urea nitrogen rechecked before and after the use of polymyxin B was used as weight information.The undirected network was constructed,and the layout format,network average,network diameter,graph density,modularization,the topology of the average path length and other parameterswere calculated.Based on K-core algorithm and degree range,the subgroup with high weight was extracted to evaluate the weight information between the usage,dosage,the course of treatment of polymyxin B and the effects oncreatinine and urea.Results:In 165 patients treated with polymxins B,creatinine level of 96 patients administrated with polymyxin B increased(58.18%),of which 58(35.15%)reached the standard of acute renal injury,while 20 of them were accompanied by urea increasing,suggesting that polymyxin B had a great influence on renal function.The network diagram of the usage and treatment of polymyxin B and creatinine or urea was constructed.Among them,the four usage levels of 50 WU/time,2 times/d;75 WU/time,2 times/d;100 WU for the first time,then 75 WU/time,2 times/d;100 WU for first time,then 50 WU/time,2 times/d had a great fluctuation on creatinine value or urea.The combined atomization method had little effect on creatinine value.The load dose was 100 WU,single administration had a great influence on renal function.Conclusion:Clinically,polymyxin B had a great impact on renal function,of which a considerable proportion was acute kidney injury.The 100 WU load dose of polymyxin B had a great impact on renal function,so attention should be paid to its adverse reactions during clinical use.