超重/肥胖对感染性心内膜炎患者的万古霉素药动学参数及不良反应的影响

Effect of overweight/obesity on the pharmacokinetic parameters and adverse reactions of vancomycin in patients with infective endocarditis

目的分析超重/肥胖对感染性心内膜炎患者万古霉素药动学的影响。方法以2019年4月~2021年8月静脉使用万古霉素且进行药物浓度监测的感染性心内膜炎患者为研究对象进行回顾性研究,根据体质量指数(BMI)将患者分为正常组(BMI<24 kg·m^(-2))和超重/肥胖组(BMI≥24 kg·m^(-2)),采用Bayesian反馈法预估药动学参数并分析超重/肥胖对万古霉素药动学及不良反应的影响。结果超重/肥胖组患者的药动学参数谷浓度(C_(min))、药时曲线下面积(AUC)和表观分布容积(V_(d))显著高于正常组(P<0.05),而谷浓度达标率和治疗有效率明显低于正常组(P<0.05)。相比正常组患者,超重/肥胖组患者总体不良反应发生率增加。结论对于感染性心内膜炎合并超重/肥胖患者,有必要开展基于治疗药物监测及Bayesian反馈法的万古霉素个体化给药方案设计。

Objective To determine the effect of overweight/obesity on the pharmacokinetic parameters of vancomycin in patients with infective endocarditis.Methods The retrospective analysis was conducted.Patients data from the hospital medical record system from April 2019 to August 2021 during the cardiovascular surgery with use of vancomycin in were collected.The subjects were divided into a normal group(BMI<24 kg·m^(-2))and an overweight/obesity group(BMI≥24 kg·m^(-2))according to body mass index(BMI).According to the population pharmacokinetic model,the measured trough concentration was used for a Bayesian approach to estimate individual pharmacokinetic parameters and analyze influence of overweight/obesity on the pharmacokinetics of vancomycin.Results The C_(min),AUC and Vd of vancomycin in the overweight/obesity patients were higher than those in the normal group,whereas the target attainment rate of C_(min)and therapeutic efficiency of vancomycin in the overweight/obesity patients were lower than those of the normal group.Compared with the normal group,the overall incidence of adverse reactions in the overweight/obesity group was increased.Conclusion Among obse patients with infective endocarditis individual dosage regimen based on TDM coupled with Bayesian forecasting is necessary.