重症感染伴肾功能亢进患者替考拉宁血药浓度影响因素分析

Analysis of influencing factors on blood concentration of teicoplanin in patients with severe infection and augmented renal clearance

目的:探究肾功能亢进(augmented renal clearance,ARC)患者替考拉宁血药浓度的影响因素。方法:回顾性分析2019年4月至2022年4月东部战区总医院重症监护室中使用替考拉宁患者的临床资料,根据肾小球清除率分为ARC组和非ARC组,比较2组患者替考拉宁血药谷浓度水平和临床各项指标,采用多重线性回归分析ARC组替考拉宁血药谷浓度的影响因素。结果:共纳入61例患者,其中ARC组40例,非ARC组21例。ARC组患者较非ARC组替考拉宁血药谷浓度更低(P=0.01),体质量更高(P<0.05),肾小球滤过率更高(P<0.01),血肌酐、胱抑素C、尿素氮更低(P<0.01),总胆红素更低(P<0.05)。多重线性回归显示,胱抑素C是ARC患者中影响替考拉宁血药谷浓度的独立因素(P<0.05)。结论:ARC患者替考拉宁血药浓度显著低于非ARC患者,建议对于重症感染的ARC患者适当增加替考拉宁给药剂量以达到目标浓度范围。胱抑素C水平能较好预测ARC患者替考拉宁谷浓度,可进一步研究将其作为替考拉宁剂量调整的参考指标的可行性,以提高患者用药的安全性和有效性。

OBJECTIVE To explore the factors affecting the blood concentration of teicoplanin in patients with augmented renal clearance(ARC).METHODS The clinical data of patients who used teicoplanin in the intensive care unit of Affiliated Jinling Hospital,Medical School of Nanjing University,from April 2019 to April 2022 were retrospectively analyzed,and they were divided into the ARC group and non-ARC group according to glomerular clearance rate.The trough serum concentration of teicoplanin and clinical indicators were compared between the two groups.Multiple linear regression was used to analyze the factors affecting the trough blood concentration of teicoplanin in the ARC group.RESULTS A total of 61 patients were included,40 in the ARC group and 21 in the non-ARC group.Patients in the ARC group had higher body weight(P<0.05),higher glomerular filtration rate(P<0.01),lower serum creatinine,serum cystatin C,lower blood urea nitrogen(P<0.01),and lower total bilirubin(P<0.05)than the non-ARC group.Multiple linear regression in ARC patients showed that cystatin C was a factor affecting the trough blood concentration of teicoplanin in ARC patients(P<0.05).CONCLUSION The level of teicoplanin blood concentration in ARC patients is significantly lower than that in non-ARC patients,and serum cystatin C is an effective marker of teicoplanin blood concentration in ARC patients,which can be considered as a reference index for the dose adjustment of teicoplanin in clinical practice to improve the safety and effectiveness of the medication.