万古霉素谷浓度预测重症肺炎疗效及肾毒性的回顾性分析

Retrospective Analysis of Nephrotoxicity and Efficacy of Vancomycin Trough Concentrations in Patients with Severe Pneumonia

关键词:  万古霉素  目标谷浓度  重症肺炎  临床疗效  肾毒性

Key words:  vancomycin  target trough concentration  severe pneumonia  clinical efficacy  nephrotoxicity

摘要:

目的 探讨接受万古霉素治疗的重症肺炎患者的目标谷浓度，研究目标谷浓度对临床疗效和肾毒性的预测价值。方法 采用回顾性、单中心、观察性对照研究。根据微生物学检查或临床情况推断为革兰阳性菌感染，分析比较110例接受万古霉素治疗的重症肺炎患者的临床资料。结果 在有效组和无效组、肾毒性组和正常组之间，万古霉素的谷浓度存在显著性差异。多因素Logistic回归分析显示，首次谷浓度是决定万古霉素临床疗效和肾毒性的唯一独立变量。临床疗效和肾毒性的ROC曲线下面积分别为0.82和0.80，最佳临界值分别为7.9 μg·mL^-1(灵敏度88%，特定性62%)和21.1 μg·mL^-1(灵敏度73%，特异性86%)。结论 万古霉素谷浓度对临床疗效和肾毒性具有较强的预测价值，通过监测血药浓度制定个体化给药方案可提高治愈率，减少药物不良反应。

Abstract:

OBJECTIVE To estimate the target trough concentration in patients with severe pneumonia, and to investigate the predict value of the target trough concentration between clinical efficacy and nephrotoxicity. METHODS In this retrospective, single-center, observational cohort study, 110 hospitalized patients with severe pneumonia who were treated with vancomycin due to bacteriologically documented or presumptive Gram-positive infections were analyzed. RESULTS A significant difference in the first trough concentration of vancomycin was observed between the response and non-response groups, and between the nephrotoxicity and non-nephrotoxicity groups. Multiple logistic regression analyses identified the first trough concentration as the only independent variable associated with clinical efficacy and nephrotoxicity of vancomycin. The areas under the ROC curves were 0.82 and 0.80 for clinical efficacy and nephrotoxicity, respectively. The cut-off values of the first trough concentration were 7.9 μg·mL^-1 for clinical efficacy (sensitivity 88%, specificity 62%) and 21.1 μg·mL^-1 for nephrotoxicity (sensitivity 73%, specificity 86%). CONCLUSION These results suggest a relationship of trough vancomycin concentration with clinical efficacy and incidence of nephrotoxicity. Serum concentration monitoring is required to achieve bset outcomes and the goal of individualized treatment of vancomycin.