替考拉宁治疗药物监测横断面调查对比研究

Comparative Research of Cross-sectional Investigation of Drug Monitoring in Treatment of Teicoplanin

目的 探讨开展替考拉宁治疗药物监测(therapeutic drug monitoring, TDM)的必要性以及中日友好医院在该方面两次调查结果对比,探索临床合理使用替考拉宁的进展情况。方法 采用横断面调查的方法,收集2020年1月1日至2020年12月31日间中日友好医院73例接受替考拉宁治疗药物监测的住院患者的临床资料,对111例次血药浓度监测数据进行统计分析,并与2018年调查结果进行对比研究。结果 替考拉宁血药谷浓度中位数为17.31(12.04,29.59)mg·L^(-1)(2020年)vs(7.77±4.31) mg·L^(-1)(2018年);血药谷浓度>10 mg·L^(-1)的89例(80.18%)(2020年)vs 11例(27.50%)(2018年);血药谷浓度>20 mg·L^(-1)的46例(41.44%)(2020年)vs 1例(2.50%)(2018年);95.71%(2020年)vs 53.01%(2018年)的患者给予了负荷剂量(P<0.000 1),采用方案最多的是600 mg q12 h(57.14%)(2020年)vs 400 mg q12 h(63.92%)(2018年),维持剂量采用最多的是600 mg qd(28.77%)(2020年)vs 400 mg qd(32.24%)(2018年);2020年血药谷浓度在正常范围(10~20 mg·L^(-1))内的患者在使用替考拉宁后,平均白细胞计数、中性粒细胞百分比及降钙素原(procalcitonin, PCT)水平较使用前显著下降;总体治疗有效率93.15%(2020年)vs 50.82%(2018年)显著改善(P<0.000 1)。结论 与2018年调查对比研究可得,替考拉宁平均用药剂量大幅增加,更接近于欧美国家的剂量,血药浓度监测例数大幅增长,谷浓度阈值达标率大大提升,更佳的平均血药谷浓度使得临床疗效得以提升。

OBJECTIVE To explore the necessity of conducting drug monitoring for the treatment of teicoplanin and to compare the results of two investigations in our hospital in this respect, and to explore the progress of clinical rational use of teicoplanin.METHODS A cross-sectional investigation was used to collect the clinical data of 73 inpatients who received our hospital monitoring of teicoplanin in the China-Japan Friendship from January 1, 2020 to December 31, 2020. The monitoring data of 111 cases of plasma drug concentration were statistically analyzed, and compared with the survey results of 2018.RESULTS The median trough concentration of teicoplanin was 17.31(12.04,29.59) mg·L^(-1)(2020) vs(7.77±4.31) mg·L^(-1)(2018).Serum trough concentration > 10 mg·L^(-1)89 cases(80.18%)(2020)vs 11 cases(27.50%)(2018);Serum trough concentration > 20 mg·L^(-1)46 cases(41.44%)(2020)vs 1 case(2.50%)(2018);95.71%(2020) vs 53.01%(2018) were given loading dose(P<0.0001), with 600 mg q12 h(57.14%)(2020) vs 400 mg q12 h(63.92%)(2018) being the most frequently dosage regimen.The most frequently used maintenance dose was 600 mg qd(28.77%)(2020) vs 400 mg qd(32.24%)(2018). In 2020,the mean white blood cell count, neutrophil percentage and procalcitonin(PCT) level of patients with serum trough concentration within the normal range(10~20 mg·L^(-1)) were significantly decreased after treatment with teicoplanin.Overall effective rate was significantly improved(93.15% vs 50.82%, P<0.000 1).CONCLUSION Compared with the investigation in 2018, the average drug dose of teicoplanin increases significantly, which is closer to the dose used in European and American countries. The number of cases monitored for plasma drug concentration increases significantly, and the threshold compliance rate of trough concentration increases significantly. Better average trough concentration could improve the clinical efficacy.