以万古霉素为例探讨基于血清肌酐与胱抑素C计算的肾小球滤过率评估肾功能亢进的阈值

Taking Vancomycin as an Example Discuss the Evaluation the Augmented Renal Clearance Threshold Values Based on Glomerular Filtration Rate Calculated by Serum Creatinine and Cystatin C

目的:基于不同的肾小球滤过率计算公式,评估肾功能亢进(Augmented Renal Clearance,ARC)阈值对儿童患者万古霉素稳态谷浓度的影响。方法:回顾性收集2018年3月至2023年6月接受万古霉素静脉输注的2~18岁儿童患者。基于血清肌酐与胱抑素C两种标志物,采用不同的公式估算肾小球滤过率(eGFR),将eGFR大于130 mL/(min·1.73 m^(2))的患者定义为ARC组,小于130 mL/(min·1.73 m^(2))的患者定义为非ARC组。两组间稳态谷浓度比较采用Mann-Whitney U检验。结果:共纳入220例儿童患者,349个稳态谷浓度点。患者的平均年龄为9.4岁。eGFR_(Schwartz)、eGFR_(CG)、eGFR_(MDRD)、eGFR_(CKD-Scr)的中位数分别为194.3 mL/(min·1.73 m^(2))、117.9 mL/(min·1.73 m^(2))、340.3 mL/(min·1.73 m^(2))、180.8 mL/(min·1.73 m^(2))。eGFR_(CKD-Scr-Cys C)、eGFR_(CKD-Cys C)、eGFR_(Hoek)的中位数分别为161.1 mL/(min·1.73 m^(2))、134.5 mL/(min·1.73 m^(2))、62.2 mL/(min·1.73 m^(2))。在Schwartz公式、MDRD公式与CKD-EPI公式计算的eGFR中,ARC组与非ARC组间的万古霉素稳态谷浓度有统计学差异(p<0.05),在Cockcroft-Gault公式、Hoek公式计算的eGFR中,ARC组与非ARC组间的万古霉素稳态谷浓度无统计学差异(p>0.05)。结论:以130 mL/(min·1.73 m^(2))为阈值,在Schwartz公式、MDRD公式与CKD-EPI公式中肾功能亢进对万古霉素稳态谷浓度有显著影响,ARC的阈值在不同计算公式中的适用性仍需进一步研究。

Objective:Based on different formulas for calculating glomerular filtration rate,the effect of augmented renal clearance(ARC) threshold on the steady trough concentration of vancomycin in children is evaluated.Methods:Data are retrospectively obtained from pediatric patients that identified 2 to 18 years who received vancomycin treatment for infection from March 2018 to June 2023.Based on serum creatinine and cystatin C,different formulas are used to estimate the glomerular filtration rate(eGFR),patients with eGFR greater than 130 mL/(min·1.73 m^(2)) are defined as ARC group,and patients with less than 130 mL/(min·1.73 m^(2)) are defined as non-ARC group.Mann-Whitney U test is used to compare the steady-state trough concentration between the two groups.Results:A total of 220 pediatric patients are included,with 349 steady-state trough concentrations.The average age of the patients is 9.4 years.The median value of eGFR_(Schwartz),eGFR_(CG),eGFR_(MDRD),eGFR_(CKD-Scr) are 194.3 mL/(min·1.73 m^(2)),117.9 mL/(min·1.73 m^(2)),340.3 mL/(min·1.73 m^(2)),180.8 mL/(min·1.73 m^(2)),respectively.The median value of eGFR_(CKD-Scr-CysC),eGFR_(CKD-CysC),eGFR_(Hoek) are 161.1 mL/(min·1.73 m^(2)),134.5 mL/(min·1.73 m^(2)),62.2 mL/(min·1.73 m^(2)),respectively.Vancomycin steady-state trough concentration between the ARC group and the non-ARC group is statistically different in Schwartz,MDRD and CKD-EPI formula(p<0.05).There is no statistically significant difference in vancomycin steady-state trough concentration between the ARC group and the non-ARC group in Cokcroft-Gault and Hoek formula(p>0.05).Conclusion:Using 130 mL/(min·1.73 m^(2)) as the threshold,augmented renal clearance has a significant effect on the vancomycin steady-state trough concentration in the Schwartz,MDRD and CKD-EPI equation.The applicability of the ARC threshold to different formulas still needs further research.