个体化给药辅助决策系统JPKD和SmartDose在万古霉素个体化给药中的应用
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篇名: 个体化给药辅助决策系统JPKD和SmartDose在万古霉素个体化给药中的应用
TITLE:
摘要: 目的:评估个体化给药辅助决策系统JPKD和SmartDose在万古霉素个体化给药中的应用。方法:以2018年4月-2019年3月在海南省人民医院住院并静脉使用万古霉素的成人患者为研究对象进行回顾性研究。使用SmartDose预测万古霉素初始给药方案的稳态血药谷浓度,计算实测浓度与预测浓度之间的绝对权重偏差和相对预测误差。采用χ2检验或连续校正的χ2检验分析患者体质量指数(BMI)正常与否、急性肾损伤(AKI)发生与否分别对绝对权重偏差的影响。对于稳态血药谷浓度不达标的患者进行万古霉素给药方案调整,使用JPKD和SmartDose系统分别预测调整给药方案后的万古霉素稳态血药谷浓度,计算实测浓度与预测浓度之间的绝对权重偏差和相对预测误差,评估两者的预测能力并针对3例患者进行实例分析。结果:SmartDose预测初始给药方案的患者入组85例,其万古霉素稳态血药谷浓度预测值为(11.36±5.96) μg/mL(2.34~29.33 μg/mL),实测浓度为(11.44±6.57) μg/mL(3.10~29.50 μg/mL),绝对权重偏差为22.95%,相对预测误差为2.72%。BMI正常与否对绝对权重偏差有显著影响(χ2=4.75,P=0.029),AKI发生与否对绝对权重偏差无显著影响(χ2=0.236,P=0.627)。JPKD和SmartDose预测调整给药方案的患者入组22例,其万古霉素的稳态血药谷浓度预测值分别为(11.06±3.58)、(12.15±4.35) μg/mL,实测浓度为(12.57±4.50) μg/mL,绝对权重偏差分别为18.30%、18.68%,相对预测误差均值分别为-8.65%、-0.44%。两个系统预测值的绝对权重偏差均<30%。3例患者预测结果的绝对权重偏差也均<30%。结论:JPKD和SmartDose系统在临床应用中对万古霉素血药浓度具有良好的预测能力,可用于优化万古霉素个体化给药方案。
ABSTRACT: OBJECTIVE: To evaluate the application of individualization dosage auxiliary system JPKD and SmartDose in individualization administration of vancomycin. METHODS: A retrospective study was conducted among adult inpatients in Hainan Provincial People’s Hospital from Apr. 2018 to Mar. 2019 with intravenous use of vancomycin. SmartDose was used to predict the steady blood trough concentration of vancomycin in the initial dosage regimen, and the absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The effects of body mass index (BMI) and acute kidney injury (AKI) on absolute weight deviation were analyzed by χ2 test or continuously corrected χ2 test. Vancomycin drug delivery scheme was adjusted for patients with ungualified steady blood drug trough concentration. JPKD and SmartDose system were used to predict the blood concentration of vancomycin after adjusting the dosage regimen. The absolute weight deviation and relative prediction error between the measured concentration and the predicted concentration were calculated. The prediction ability of the two systems was evaluated and 3 examples was analyzed. RESULTS: Predicted steady blood trough blood concentration of 85 included patients in SmartDose predicted initial dosage regimen were (11.36±5.96) μg/mL (2.34-29.33   μg/mL); the measured concentration was (11.44±6.57) μg/mL (3.10-29.50 μg/mL); absolute weight deviation was 22.95%, and the relative prediction error was 2.72%. Whether BMI was normal or not had significant effects on the absolute weight deviation   (χ2=4.75, P=0.029), and whether AKI occurred or not had no significant effects on the absolute weight deviation (χ2=0.236, P=0.627). JPKD and SmartDose predicted that predicted steady blood trough concentrations of vancomycin in 22 included patients were (11.06±3.58) and (12.15±4.35) μg/mL, and the measured concentration was (12.57±4.50) μg/mL; absolute weight deviations were 18.30% and 18.68%; relative prediction errors were -8.65% and -0.44%, respectively. The absolute weight deviations of the predicted values of the two systems were less than 30%. The absolute weight deviations of prediction results were also less than 30% in 3 patients. CONCLUSIONS: JPKD and SmartDose system have good predictive ability for blood concentration of vancomycin in clinical application, and can be used to optimize the individualized administration of vancomycin.
期刊: 2019年第30卷第19期
作者: 林良沫,符祥俊,陈君,钟莉莉,吴琼诗,黄春新,王敏
AUTHORS: LIN Liangmo,FU Xiangjun,CHEN Jun,ZHONG Lili,WU Qiongshi,HUANG Chunxin,WANG Min
关键字: 万古霉素;个体化给药辅助系统;JPKD;SmartDose;血药浓度;预测
KEYWORDS: Vancomycin; Individualization dosage auxiliary system; JPKD; SmartDose; Blood concentration; Prediction
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