血液透析治疗对利福平血药浓度影响的研究

A study on the effect of hemodialysis on the blood concentration of rifampicin

目的通过分析血液透析患者的利福平血药浓度特征,了解血液透析治疗是否影响利福平血药浓度,为长期接受血液透析的患者制定科学抗结核治疗方案提供依据。方法分析2021年7月至2022年7月在南宁市第四人民医院肺结核住院患者149例,将患者分为血透组(43例)和非血透组(106例),利用高效液相色谱分析方法分别检测患者接受四联规范抗结核治疗第8天当天经利福平治疗后2h、4h、6h的利福平血药浓度。结果血透组患者利福平血药浓度与非血透组差异无统计学意义,均P>0.05;抗结核治疗后出现肝功能异常及肝损伤加重患者,利福平血药浓度偏高,P<0.05。血透组中出现血药浓度延迟的比例偏高,且血透组中口服患者所占比例偏高。结论血液透析对利福平血药浓度无明显影响,无需追加利福平用药剂量;血透组利福平血药浓度延迟比率高于非血透组,考虑受口服给药方式的影响。条件允许情况下结合用药后2h、4h、6h利福平血药浓度,个性化制定抗结核治疗方案,可保证利福平有效血药浓度及治疗效果。

Objective By analyzing the characteristics of rifampicin concentration in hemodialysis patients,to understand whether hemodialysis treatment affects rifampicin concentration,and to provide a basis for the scientific anti-tuberculosis treatment plan for patients receiving long-term hemodialysis.Method Analyzed 149 patients hospitalized with pulmonary tuberculosis in the Fourth People's Hospital of Nanning City from July 2021 to July 2022,and divided the patients into hemodialysis group(43 cases)and non-hemodialysis group(106 cases).By using high performance liquid chromatography analysis to measure the changes of rifampicin blood concentration on post rifampin treatment on days 8 at 2 hours,4 hours and 6hours.Result There was no statistically significant difference in the blood concentration of rifampicin between hemodialysis group and non-hemodialysis group(P>0.05).Higher rifampicin blood levels accompanied by a sever hepatic dysfunction and exacerbate liver injury after anti-tuberculosis treatmen(P<0.05).The ratio of delayed blood concentration and oral patients is overrepresented in the haemodialysis group.Conclusion There was no significant effect of haemodialysis on the blood concentration of rifampicin,and no top-up dose was needed;the ratio of rifampicin blood level in the haemodialysis group was higher than that in the non-haemodialysis group,which was considered to be affected by the orally.Individualized anti-tuberculosis treatment basing on the blood concentration of rifampicin at 2h,4h and 6h after the use of drugs can ensure the therapeutic effects.