摘要
目的:解析患儿体内万古霉素血药质量浓度的影响因素,进而研究并提出针对性的万古霉素用药方案优化策略。方法:回顾性搜集自2016年1月至2023年12月于南京医科大学附属儿童医院接受万古霉素治疗且进行血液药物质量浓度监测的出院患儿数据,依照《中国万古霉素治疗药物监测指南》所设定的万古霉素血液谷质量浓度标准,分为亚治疗质量浓度(低于10 mg·L^(-1))、治疗浓度(10~20 mg·L^(-1))以及超治疗质量浓度(高于20 mg·L^(-1))。采用单因素方差分析以识别各质量浓度组的组间差异,并运用无序多分类Logistic回归模型剖析万古霉素血药质量浓度水平的独立变量。结果:147例患儿中,27例(18.4%)血药质量浓度达标,102例(69.4%)未达下限,18例(12.2%)超出上限。单变量解析显示3个质量浓度组年龄、利尿剂、血管活性药物、血清谷草转氨酶、胱抑素-C质量浓度和肾小球滤过率差异有统计学意义(P<0.05)。无序多分类Logistic回归分析表明,肾小球滤过率上升,药物谷质量浓度降至亚治疗水平概率降低;胱抑素-C质量浓度提升,谷质量浓度超出治疗阈值概率降低。结论:患儿万古霉素血药质量浓度达标比例偏低,用药策略调整须考虑肾功能及胱抑素-C等因素。
Objective:To analyze the influencing factors of vancomycin blood concentration in pediatric patients,and to propose targeted optimization strategies for vancomycin medication regimens.Methods:A retrospective collection of data from pediatric patients discharged from the Children s Hospital of Nanjing Medical University from January 2016 to December 2023 who received vancomycin treatment and blood drug concentration monitoring.According to the vancomycin trough concentration standards set by the“Chinese Guidelines for Therapeutic Drug Monitoring of Vancomycin”,the patients were divided into subtherapeutic concentration(below 10 mg·L^(-1)),therapeutic concentration(between 10-20 mg·L^(-1)),and supratherapeutic concentration(above 20 mg·L^(-1)).One-way ANOVA was used to identify differences between concentration groups,and multivariate Logistic regression models were employed to analyze the independent variables affecting vancomycin blood concentration.Results:Of the 147 pediatric patients,27(18.4%)had blood concentrations within the therapeutic range,102(69.4%)had concentrations below the lower limit,and 18(12.2%)had concentrations above the upper limit.Univariate analysis showed significant differences in age,diuretics,vasoactive drugs,serum aspartate aminotransferase,cystatin C concentration,and glomerular filtration rate.Multivariate disordered multi-class Logistic regression analysis indicated that the glomerular filtration rate increased and the probability of the drug trough concentration dropping to the subtherapeutic level decreased.When the concentration of cystatin C increased,the probability of the trough concentration exceeding the treatment threshold decreased.Conclusion:The proportion of pediatric patients with vancomycin blood concentrations within the therapeutic range is low,and factors such as renal function and cystatin C should be considered when adjusting medication strategies.
作者
屈林林
刘瑶
李文静
陈峰
葛许华
QU Linlin;LIU Yao;LI Wenjing;CHEN Feng;GE Xuhua(Department of Pediatrics,the Affiliated Suqian First People's Hospital of Nanjing Medical University,Suqian 223800,China;Pharmacy Department,Children s Hospital of Nanjing Medical University,Nanjing 210009,China;Pharmaceutical Research Center,Children s Hospital of Nanjing Medical University,Nanjing 210009,China;Pediatric Intensive Care Unit,Children s Hospital of Nanjing Medical University,Nanjing 210009,China)
出处
《东南大学学报(医学版)》
2025年第4期667-672,共6页
Journal of Southeast University(Medical Science Edition)
