群体药代动力学软件对肾功能亢进与非亢进骨科术后患者万古霉素谷浓度、AUC_(0~24h)的预测分析

Prediction Analysis of Vancomycin Trough Concentration and AUC_(0~24h)by Population Pharmacokinetic Softwares in Patients with Augmented Renal Clearance or Non-augmented Renal Clearance after Orthopedic Surgery

目的:探讨群体药代动力学软件对肾功能亢进(ARC)和非亢进(non-ARC)骨科术后患者的万古霉素谷浓度、24 h药时曲线下面积(AUC_(0~24h))的预测效果。方法:收集我院2018年1月~2022年12月骨科术后使用万古霉素的患者,通过HIS系统收集患者的基本信息、万古霉素峰谷浓度、血常规和生化指标等,计算患者肌酐清除率,并分为ARC组和non-ARC组。采用万古霉素剂量推荐和血药浓度预测系统、SmartDose软件回顾性预测患者的万古霉素谷浓度,采用SmartDose和JPKD软件预测万古霉素的AUC_(0~24h)。结果:与non-ARC组相比,ARC组患者年龄较小,血肌酐、血尿素、胱抑素C水平明显降低,而肌酐清除率较高(P<0.05)。与non-ARC组相比,ARC组患者谷浓度及AUC_(0~24h)均明显降低(P<0.05)。万古霉素剂量推荐和血药浓度预测系统和SmartDose软件对ARC与non-ARC骨科术后患者谷浓度预测的绝对权重偏差>30%。JPKD软件对ARC与non-ARC骨科术后患者AUC_(0~24h)的绝对权重偏差<30%且组内相关系数均>0.750。结论:万古霉素剂量推荐和血药浓度预测系统和SmartDose软件预测ARC和non-ARC骨科术后患者万古霉素谷浓度效果欠佳,而JPKD软件较SmartDose软件更适用于预测AUC_(0~24h)。

Objective:To investigate the analysis of the predictive effect of population pharmacokinetic software on vancomycin trough concentrations and AUC_(0~24h)h in patients with augmented renal clearance(ARC)and non-ARC post-operative orthopedics.Methods:Patients who used vancomycin after orthopedic surgery in our hospital from January 2018 to December 2022 were collected and their basic information,vancomycin peak and trough concentrations,routine blood and biochemical parameters were included by His system to calculate the creatinine clearance of patients and divided into augmented renal clearance and non-augmented renal clearance groups.“Vancomycin dose recommendation tool,blood concentration prediction tool”and SmartDose software were used to retrospectively predict vancomycin trough concentration of patients,and SmartDose and JPKD software were used to predict vancomycin AUC_(0~24h)h.Results:Compared with the non-ARC group,patients in the ARC group were younger and had significantly lower blood creatinine,blood urea,and cystatin C levels and higher creatinine clearance,all with significant differences(P<0.05).Trough concentration and AUC_(0~24h)h were significantly lower in the ARC group compared with the non-ARC group,with significant differences(P<0.05).“Vancomycin Dose Recommendations and Blood Concentration Prediction”and SmartDose software had an absolute weighted deviation of>30%in predicting trough concentrations in ARC and non-ARC postoperative orthopaedic patients.The JPKD software had an absolute weighted deviation of<30%in predicting the AUC_(0~24h)h in ARC and non-ARC postoperative orthopaedic patients and the intraclass correlation efficient were>0.750.Conclusion:“Vancomycin dose recommendation and blood concentration prediction”and SmartDose software are not effective in predicting vancomycin trough concentration in patients with ARC and non-ARC orthopedic surgery,while JPKD software is more suitable for predicting AUC_(0~24h)h than SmartDose software.