肾功能亢进对替考拉宁高剂量治疗方案下患者血药谷浓度的影响
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篇名: 肾功能亢进对替考拉宁高剂量治疗方案下患者血药谷浓度的影响
TITLE: Effects of Augmented Renal Clearance on Blood Trough Concentration of Patients Receiving High-dose Regimen of Teicoplanin
摘要: 目的:研究肾功能亢进(ARC)对替考拉宁高剂量给药方案下患者血药谷浓度的影响。方法:前瞻性收集2018年7月至2020年6月南京医科大学附属苏州医院/苏州市立医院重症监护室中目标性治疗使用替考拉宁高剂量方案的患者,根据矫正肌酐清除率分为ARC组和肾功能正常组。两组患者的替考拉宁给药方案均为负荷剂量600mg,q12h×3剂,维持剂量6~10mg/kg,qd,并结合肌酐清除率及血药谷浓度调整给药剂量。采用高效液相色谱法测定两组患者在替考拉宁第4剂给药前30min和第8~10剂给药前30min的血药谷浓度,对比两组患者替考拉宁血药谷浓度、临床有效率、革兰氏阳性菌清除率及不良反应发生情况。结果:共纳入56例患者,18例纳入ARC组、38例纳入肾功能正常组。ARC组患者较肾功能正常组患者更年轻(P<0.001),血清白蛋白水平更低(P=0.025)。ARC组患者第4剂给药前和第8~10剂给药前血药谷浓度均低于肾功能正常组(P=0.034;P=0.035)。ARC组和肾功能正常组患者的第8~10剂给药前血药谷浓度均高于同组第4剂给药前血药谷浓度(P=0.003;P<0.001)。ARC组临床有效率为77.8%、革兰氏阳性菌清除率为76.2%,均较肾功能正常组低,但差异无统计学意义(P=0.195;P=0.223)。两组患者均未出现肝功能损害、血细胞减少、过敏反应等情况,但肾功能正常组有1例患者的急性肾损害与替考拉宁用药的因果关系被评定为“很可能”。结论:ARC患者更年轻、多数存在低蛋白血症,其在替考拉宁高剂量治疗方案下的血药谷浓度较肾功能正常者显著降低。建议对危重症感染的ARC患者宜加大替考拉宁负荷剂量以使其血药谷浓度快速达标。
ABSTRACT: OBJECTIVE:To study the effects of augmented renal clearance (ARC)on blood trough concentration of patients receiving high-dose regimen of teicoplanin. METHODS :Patients who received high-dose regimen of teicoplanin in the ICU were prospectively collected from the Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital during Jul. 2018-Jun. 2020. They were divided into ARC group and normal renal function group according to corrected creatinine clearance. The dosage regimen of teicoplanin in the two groups were loading dose of 600 mg,q12 h×3 doses,maintenance dose of 6-10 mg/kg,qd,and the dosage was adjusted in combination with creatinine clearance rate and blood trough concentration. The trough concentration of blood samples which were collected 30 min before the 4th and 8th-10th dosage of teicoplanin were determined by HPLC. Trough concentration ,clinical efficacy ,Gram-positive bacterial clearance rate and the occurrence of ADR were compared between 2 groups. RESULTS :A total of 56 patients were included and divided into ARC group (18 cases)and normal renal function group (38 cases). ARC group had younger age (P<0.001)and lower serum albumin level (P=0.025)than normal renal function group. The trough concentrations before administration of the 4th and 8th-10th dosage in ARC group were lower than normal renal function group (P=0.034;P=0.035). The trough concentrations in the ARC group and normal renal function group before 8th-10th dosage were all higher than 30 min before the 4th dosage (P=0.003;P<0.001). The clinical efficacy rate and the clearance rate of Gram-positive bacteria in ARC group were 77.8% and 76.2%,which were lower than those of the normal renal function group ,but there was no statistical difference (P=0.195;P=0.223). There was no liver function damage ,hemocytopenia and allergic reaction in both groups ,but in the normal renal function group ,the causal relationship between acute renal damage and teicoplanin was assessed as “very likely ”in one patient. CONCLUSIONS :ARC patients are younger ,most of them have hypoproteinemia,and the blood trough concentrations of teicoplanin in high-dose regimen are significantly lower than those of normal renal function patients. For critical ill ARC patients ,it is advisable to increase the loading dose of teicoplanin to make the trough concentration reach the target concentration range quickly.
期刊: 2020年第31卷第21期
作者: 唐莲,石璐,薛宏志,庄智伟,袁云龙,钱春霞,朱金伟,许晓文,朱亚松,刘纪松,沈奕,陆件
AUTHORS: TANG Lian,SHI Lu,XUE Hongzhi,ZHUANG Zhiwei, YUAN Yunlong,QIAN Chunxia,ZHU Jinwei,XU Xiaowen,ZHU Yasong,LIU Jisong,SHEN Yi,LU Jian
关键字: 肾功能亢进;替考拉宁;高剂量;血药谷浓度;临床疗效
KEYWORDS: Augmented renal clearance ;Teicoplanin;High dosage ;Blood trough concentration ;Clinical efficacy
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