两性霉素B脂质体引起低钾血症的危险因素分析

Analysis of risk factors for hypokalemia caused by amphotericin B liposome

目的 探讨两性霉素B脂质体引起低钾血症的危险因素,为临床合理用药提供参考。方法 回顾性分析2012年1月至2021年12月在海南医学院第一附属医院住院期间使用两性霉素B脂质体的患者信息,收集其两性霉素B脂质体的使用详情和钾剂补充情况,按照是否发生低钾血症分成低钾血症组和正常组,采用单因素及多因素Logistic回归分析法分析两性霉素B脂质体引起低钾血症的危险因素。结果 共纳入121例患者,其中低钾血症组60例、正常组61例。低钾血症组患者的两性霉素B脂质体维持剂量、累积剂量、最大日剂量(重度低钾血症患者)、治疗天数、出现低钾血症的时间、每日补钾剂量(中、重度低钾血症患者)、总补钾天数(中度低钾血症患者)均显著高于或长于正常组(P<0.05)。单因素分析结果显示,两性霉素B脂质体累积剂量≥200mg、治疗天数≥5 d对该药引起低钾血症有显著影响(P<0.05)。多因素分析结果显示,患者存在基础低血钾、体重<50 kg、两性霉素B脂质体累积剂量≥200 mg、治疗天数≥5 d是该药引起低钾血症的独立危险因素(P<0.05)。结论 两性霉素B脂质体引起低血钾症的发生率较高,其引起低钾血症的独立危险因素为累积剂量≥200 mg、治疗天数≥5 d、患者存在基础低血钾及体重<50kg。建议在应用该药治疗前将患者血清钾补充至正常水平,给药期间密切监测血清钾变化,以减少低钾血症的发生。

OBJECTIVE To investigate the risk factors for hypokalemia caused by amphotericin B liposome,and to provide reference for clinical use of drugs.METHODS A retrospective analysis was used to collect the information of patients who used amphotericin B liposome during the hospitalization in First Affiliated Hospital of Hainan Medical College from January 2012 to December 2021.The details of use information about amphotericin B liposome and the potassium supplementation were collected.The patients were divided into hypokalemia group and normal group according to the occurrence of hypokalemia.Univariate and multi-variate Logistic regression analyses were used to analyze the risk factors for hypokalemia induced by amphotericin B liposome.RESULTS Of the 121 patients included in this analysis,60 patients were in hypokalemia group,61 patients were in normal group.The following parameters of the hypokalemic group were significantly higher or longer than those of the normal group,such as the maintenance dose,cumulative dose and maximum daily dose(in patients with severe hypokalemia) of amphotericin B liposome,treatment days,the maintained days of hypokalemia,daily dose of potassium supplement(in patients with moderate or severe hypokalemia),the duration of potassium supplement(in patients with moderate hypokalemia).Results of single factor analysis showed that the cumulative dose of amphotericin B liposome ≥200 mg and the duration of treatment ≥5 days were independent risk factors of hypokalemia caused by this drug(P<0.05).Multi-variate analysis results showed that the presence of basic hypokalemia,body weight <50 kg,cumulative dose of amphotericin B liposome ≥200 mg and the duration of treatment ≥5 days were the independent risk factors for hypokalemia caused by amphotericin B liposome(P<0.05).CONCLUSIONS The incidence of hypokalemia caused by amphotericin B liposome is high,the independent risk factors for hypokalemia include cumulative dose ≥200 mg,treatment days ≥5 days,the presence of basic hypokalemia and body weight <50 kg.It is suggested that serum potassium should be elevated to normal level before amphotericin B liposome treatment,and the level of serum potassium should be monitored during medication to reduce the occurrence of hypokalemia.