肿瘤患者万古霉素血药浓度达标的影响因素分析

Factors affecting target attainment of serum vancomycin concentration in tumor patients

目的通过分析肿瘤患者使用万古霉素治疗时血药浓度的特点,探讨造成其不达标或超标可能的影响因素。方法通过监测肿瘤患者万古霉素的血药浓度,采用SPSS软件统计分析不同血药浓度水平下的临床特征差异有无统计学意义,并分析各伴发因素对血药浓度达标情况的影响。结果57例患者中,万古霉素的平均谷浓度为(12.08±8.20)mg/L,达标患者仅有17例,占29.82%;不达标患者最多,达29例,占50.88%;超标患者有11例,占19.30%;三组之间的差异具有统计学意义(P<0.05)。不达标组与达标组患者在年龄、肿瘤类型、肿瘤远处转移、用药前1个月治疗方案(手术、放疗、化疗)和肾功能亢进等方面,差异有统计学意义(P<0.05),超标组与达标组患者在用药前1个月接受过放疗方面的差异具有统计学意义(P<0.05)。逐步logistic回归分析结果显示,肾功能亢进是影响万古霉素谷浓度不达标的主要因素(P<0.05)。结论肿瘤患者使用万古霉素的达标概率低,用药时应综合考虑患者年龄、肿瘤分期、用药前1个月内的治疗情况及肾功能状况,进行万古霉素给药方案的优化,推荐进行血药浓度监测以确保其疗效与安全性。

Objective To investigate the potential factors associated with failure to attain or exceeding the target serum concentration of vancomycin by analyzing the serum concentration-time profiles of vancomycin in tumor patients.Methods The serum concentration of vancomycin was monitored in tumor patients during vancomycin treatment.Statistical software SPSS was used to analyze the difference of clinical characteristics under different serum concentrations of vancomycin,and so as to profile various variables that may affect attainment of target serum concentration of vancomycin.Results The mean trough concentration of vancomycin was(12.08±8.20)mg/L in 57 patients.The target serum concentration of vancomycin was attained in only 17patients(29.82%).Vancomycin failed to attain the target concentration in 29 cases(50.88%),and exceeded the target concentration in 11 patients(19.30%).The difference among the three groups was statistically significant(P<0.05).Patient age,tumor type,distant metastasis,anti-tumor therapy(surgery,radiotherapy,or chemotherapy)1 month before administration of vancomycin,and augmented renal clearance showed statistically significant difference(P<0.05)between the patients failing to attain target concentration of vancomycin and those successful in target attainment.Radiotherapy 1 month before administration of vancomycin showed statistically significant difference(P<0.05)between the patients successful in attaining the target concentration of vancomycin and those having a concentration beyond the target.Stepwise Logistic regression analysis showed that augmented renal clearance was the main factor leading to trough concentration of vancomycin lower than the target(P<0.05).Conclusions Vancomycin treatment does not attain the target serum concentration in most of the tumor patients.The dosing regimen of vancomycin should be optimized in terms of patient’s age,tumor stage,antitumor therapy 1 month before administration of vancomycin,and renal function.It is recommended to perform therapeutic drug monitoring for vancomycin to ensure both efficacy and safety.