我院万古霉素稳态谷浓度和血药浓度曲线下面积监测结果的情况分析

Analysis of the monitoring results of steady trough concentration and area under the curve of vancomycin in our hospital

关键词:  万古霉素  稳态谷浓度  24小时血药浓度曲线下面积  急性肾损伤

Key words:  vancomycin  steady trough concentration  24-hour area under the curve  acute kidney injury

摘要:

目的：比较我院万古霉素稳态谷浓度（Cmin）和24小时血药浓度曲线下面积（AUC0-24h）监测结果的分布情况，并对Cmin和AUC0-24h超出目标范围上限的情况进行影响因素分析。方法：选取2021.09~2023.03就诊于我院接受万古霉素治疗并同时测定稳态峰、谷浓度的患者，按照Cmin是否大于20 mg/L和AUC0-24h是否大于650 mg·h·L-1各分为两组，分别进行相关影响因素分析。结果：研究纳入68例患者，共收集103对万古霉素稳态峰浓度和谷浓度。约50%的患者出现Cmin和AUC0-24h超出目标范围上限，Cmin和AUC0-24h具有良好的线性相关性（相关系数r =0.9492, p＜0.05）；住院期间存在AKI或CKD（OR 7.18，95%CI 1.41~36.53，p＜0.05）以及浓度测定后调整给药方案（OR 10.61，95%CI 3.33~33.78，p＜0.05）是Cmin＞20 mg/L的独立影响因素，而仅浓度测定后调整给药方案是AUC0-24h＞650 mg·h·L-1的独立影响因素（OR 6.15，95%CI 2.05~18.45，p＜0.05）。结论：我院约50%患者存在万古霉素谷浓度和AUC超出目标范围上限，虽然浓度测定后多数已调整给药方案，但安全起见，建议用药前评估患者的肾功能状态，适当降低初始经验性给药剂量。

Abstract:

OBJECTIVE To compare the distribution of monitoring results of steady trough concentration (Cmin) and 24-hour area under the curve (AUC0-24h) of vancomycin in our hospital, and analyze the influencing factors of Cmin and AUC0-24h exceeding the upper limit of the target range. METHODS Patients who received vancomycin treatment in our hospital from September 2021 to March 2023 and measured the steady-state peak and trough concentrations at the same time were divided into two groups according to whether Cmin was greater than 20 mg/L and AUC0-24h was greater than 650 mg·h·L-1, and the related influencing factors were analyzed respectively. RESULTS 68 patients were included in the study, and 103 pairs of peak and valley concentrations of vancomycin were collected. About 50% patients have Cmin and AUC0-24h exceeding the upper limit of the target range, and there is a good linear correlation between Cmin and AUC0-24h（correlation coefficient r =0.9492, p＜0.05）. The presence of AKI or CKD during hospitalization（OR 7.18，95%CI 1.41~36.53，p＜0.05）and the adjustment of dosage regimen after concentration determination (OR 10.61, 95%CI 3.33~33.78, p < 0.05) are independent influencing factors for Cmin > 20 mg/L, while adjusting the dosage regimen after concentration determination is the independent influencing factor of AUC0-24h> 650 mg·h·L-1 (OR 6.15, 95% CI 2.05~18.45, p < 0.05). CONCLUSION About 50% of patients in our hospital have vancomycin trough concentration and AUC exceeding the upper limit of the target range. Although most of them have adjusted the dosage regimen after concentration determination, it is suggested to evaluate the renal function of patients before administration and appropriately reduce the initial empirical dosage.