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儿童患者万古霉素稳态血药浓度谷值与AUC24/MIC的相关性及治疗失败的危险因素分析
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| 篇名： | 儿童患者万古霉素稳态血药浓度谷值与AUC24/MIC的相关性及治疗失败的危险因素分析 |
| TITLE： | Correlation of the steady-state minimal concentration with AUC24/MIC of vancomycin and analysis of risk factors for treatment failure in pediatric patients |
| 摘要： | 目的 评估儿童患者万古霉素稳态血药浓度谷值（cmin）与24h药时曲线下面积（AUC24）/最小抑菌浓度（MIC）比值（AUC24/MIC）的相关性，并分析万古霉素治疗失败的独立危险因素。方法回顾性收集2021年1月至2024年7月于我院使用万古霉素治疗且进行治疗药物监测的住院患儿资料，按治疗是否成功分为成功组和失败组。采用Spearman相关性分析评估万古霉素cmin与AUC24/MIC的相关性，采用单因素及多因素Logistic回归分析筛选万古霉素治疗失败的独立危险因素。结果共纳入59例患儿，成功组41例、失败组18例。与失败组比较，成功组患儿的万古霉素AUC24/MIC显著升高（P＝0.038）；但两组患儿的cmin比较，差异无统计学意义（P＞0.05）。万古霉素的cmin与AUC24/MIC呈显著正相关（r＝0.499，P＜0.001），但其对AUC24/MIC达标（≥400）有一定的预测效能（受试者操作特征曲线下面积＝0.696），Youden指数确定的最佳截断值为6.05mg/L。AUC24/MIC预测治疗失败的效能优于cmin（受试者操作特征曲线下面积为0.671vs.0.523，P为0.038vs.0.684），敏感性更高（83.3%vs.66.7%）。低蛋白血症和AUC24/MIC≤369.1是导致万古霉素治疗失败的独立危险因素（P＜0.05）。患儿肾毒性发生率为3.4%。结论儿童患者万古霉素的cmin与AUC24/MIC呈显著正相关；低蛋白血症和AUC24/MIC≤369.1是导致患儿万古霉素治疗失败的独立危险因素。 |
| ABSTRACT： | OBJECTIVE To assess the correlation between the steady-state minimal concentration （cmin） and 24 h area under the drug concentration-time curve （AUC24）/minimal inhibitory concentration （MIC） ratio （AUC24/MIC） of vancomycin in pediatric patients， and analyze independent risk factors for treatment failure. METHODS Data of hospitalized children treated with vancomycin and receiving therapeutic drug monitoring in our hospital from January 2021 to July 2024 were retrospectively collected and divided into success group and failure group according to whether the treatment was successful or not. Spearman correlation analysis was used to analyze the correlation between cmin and AUC24/MIC of vancomycin， and one-way and multifactorial Logistic regression analyses were used to screen the independent risk factors for vancomycin treatment failure. RESULTS A total of 59 children were included， with 41 in the success group and 18 in the failure group. Compared with the failure group， AUC24/MIC of vancomycin was significantly higher in the success group （P＝0.038）， but there was no statistically significant difference in the cmin of the two groups （P＞0.05）； cmin of vancomycin was significantly positively correlated with AUC24/MIC （r＝0.499， P＜0.001）， but it has a certain efficacy in predicting the achievement of the AUC24/MIC standard （≥400） （area under the receiver operator characteristic curve＝0.696）， with an optimal cutoff value of 6.05 mg/L determined by the Youden index. The efficacy of AUC24/ MIC in predicting treatment failure was superior to cmin （areas under the receiver operator characteristic curve were 0.671 vs. 0.523， P were 0.038 vs. 0.684）， with higher sensitivity （83.3% vs. 66.7%）. Hypoproteinemia and AUC24/MIC≤369.1 were independent risk factors for vancomycin treatment failure （P＜0.05）. The incidence of nephrotoxicity was 3.4%. CONCLUSIONS There is a significant positive correlation between cmin and AUC24/MIC of vancomycin in pediatric patients； hypoproteinemia and AUC24/MIC≤369.1 are independent risk factors for vancomycin treatment failure in children. |
| 期刊： | 2025年第36卷第09期 |
| 作者： | 林金香；王幼鸿；肖智锋；王晶；宋颖；蔡凝芳；吴秀萍 |
| AUTHORS： | LIN Jinxiang，WANG Youhong，XIAO Zhifeng，WANG Jing，SONG Ying，CAI Ningfang，WU Xiuping |
| 关键字： | 万古霉素；稳态血药浓度谷值；24 h药时曲线下面积；最小抑菌浓度；相关性；危险因素 |
| KEYWORDS： | vancomycin； steady-state minimal concentration； 24 h area under the drug concentration-time curve； minimal |
| 阅读数： | 10 次 |
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