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复方磺胺甲噁唑及其代谢物血药峰浓度与危重症患者临床疗效及不良反应的相关性研究
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| 篇名： | 复方磺胺甲噁唑及其代谢物血药峰浓度与危重症患者临床疗效及不良反应的相关性研究 |
| TITLE： | Study on the correlation of peak blood concentrations of compound sulfamethoxazole and its metabolites with clinical efficacy and adverse reactions in critically ill patients |
| 摘要： | 目的 分析复方磺胺甲噁唑（简称“TMP/SMZ”）及其代谢物N-乙酰基磺胺甲噁唑（NSMZ）血药峰浓度（cmax）与危重症患者临床疗效及不良反应的相关性。方法回顾性收集2023年12月至2025年1月海南省人民医院重症监护室（ICU）使用TMP/SMZ治疗的危重症患者资料，按治疗后是否成功分为成功组和失败组。采用简单线性回归和Spearman相关分析法分析TMPcmax、SMZcmax及NSMZcmax与临床疗效及不良反应的相关性；采用受试者工作特征曲线（ROC）预测不良反应发生时的截断值。结果在入住ICU24h内急性生理与慢性健康评分Ⅱ（APACHE-Ⅱ）≥15分的危重症患者中，成功组患者的SMZcmax显著高于失败组（P＜0.05）。TMP/SMZ每日总剂量与TMPcmax、SMZcmax呈正相关（P＜0.05）。TMPcmax与肝毒性和肾毒性、SMZcmax与肝毒性、NSMZcmax与肾毒性有相关性（P＜0.05）。TMPcmax预测肾毒性和肝毒性的截断值分别为7.25、6.63μg/mL，SMZcmax预测肝毒性的截断值为138.00μg/mL，NSMZcmax预测肾毒性的截断值为60.76μg/mL。结论入住ICU24h内APACHE-Ⅱ≥15分的危重症患者中，SMZcmax与治疗成功存在关联。TMPcmax≥6.63μg/mL、SMZcmax≥138.00μg/mL时，患者的肝毒性发生风险显著增加；TMPcmax≥7.25μg/mL、NSMZcmax≥60.76μg/mL时，患者的肾毒性发生风险显著增加。 |
| ABSTRACT： | OBJECTIVE To analyze the correlation of the peak blood concentration （cmax） of compound sulfamethoxazole （TMP/SMZ） and its metabolite N-acetyl sulfamethoxazole （NSMZ） with clinical efficacy and adverse reactions in critically ill patients. METHODS The data of critically ill patients treated with TMP/SMZ in various ICU of Hainan General Hospital from December 2023 to January 2025 were retrospectively collected. The patients were divided into success group and failure group based on the treatment outcome. Simple linear regression and Spearman correlation analysis were used to analyze the correlation of TMP cmax， SMZ cmax， and NSMZ cmax with clinical efficacy and adverse reactions. The receiver operating characteristic curve （ROC） was used to determine the cutoff values of cmax for predicting the occurrence of adverse reactions. RESULTS Among critically ill patients with an acute physiology and chronic health evaluation Ⅱ （APACHE-Ⅱ） ≥15 points 24 h of check-in at ICU， SMZ cmax of success group was significantly higher than failure group （P＜0.05）. The daily total dose of TMP/SMZ was positively correlated with TMP cmax and SMZ cmax（ P＜0.05）. TMP cmax was significantly correlated with hepatotoxicity and nephrotoxicity， SMZ cmax with hepatotoxicity， and NSMZ cmax with nephrotoxicity （P＜0.05）. The cutoff values of TMP cmax for predicting nephrotoxicity and hepatotoxicity were 7.25 μg/mL and 6.63 μg/mL， respectively. The cutoff value of SMZ cmax for predicting hepatotoxicity was 138.00 μg/mL， and that of NSMZ cmax for predicting nephrotoxicity was 60.76 μg/mL. CONCLUSIONS Among critically ill patients with an APACHE-Ⅱ ≥15 points 24 h of check-in at ICU， SMZ cmax is associated with treatment success. Hepatotoxicity risk significantly increases when TMP cmax ≥6.63 μg/mL or SMZ cmax ≥138.00 μg/mL； nephrotoxicity risk significantly increases when TMP cmax ≥7.25 μg/mL or NSMZ cmax ≥60.76 μg/mL. |
| 期刊： | 2025年第36卷第14期 |
| 作者： | 符香香；钟莉莉；顾江帆；梅蒙玉；李欣欣；邓阳；王敏 |
| AUTHORS： | FU Xiangxiang，ZHONG Lili，GU Jiangfan，MEI Mengyu，LI Xinxin，DENG Yang，WANG Min |
| 关键字： | 复方磺胺甲噁唑；N-乙酰基磺胺甲噁唑；危重症患者；血药峰浓度；临床疗效；不良反应 |
| KEYWORDS： | compound sulfamethoxazole； N-acetyl-sulfamethoxazole； critically ill patients； peak blood concentration； clinical |
| 阅读数： | 9 次 |
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