万古霉素血药谷浓度与疗效及肾功能的相关性分析  

Correlation between Blood Vancomycin Peak Concentration with Clinical Efficacy and Renal Function

作　　者：赵永红[1,2] 沈德莉[1,2] 翁丽贞[1,2] 

机构地区：[1]上海市静安区中心医院 [2]复旦大学华山医院静安分院,上海200040

出　　处：《中国药业》2015年第10期71-73,共3页China Pharmaceuticals

摘　　要：目的分析万古霉素血药谷浓度与临床疗效及肾功能的相关性,为个体化用药提供参考。方法选择2012年12月至2015年1月医院收治的感染患者62例,监测万古霉素血药谷浓度,定期检测肾功能,治疗后评价临床疗效,记录不良反应发生情况。结果 62例患者中,44例（70.97%）血药谷浓度不低于10 mg/L,达到目标值;临床总有效率为83.87%,3种不同谷浓度组[〈10 mg/L（A组）,10-15 mg/L（B组）,〉15 mg/L（C组）]的患者疗效比较,无显著性差异。A组（〈10 mg/L）的肾功能损伤发生率为11.36%（5/44）;C组（〉15 mg/L）与A＋B组（〈15 mg/L）比较,前组的肾毒性较后组高4倍。结论万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）、耐甲氧西林表皮葡萄球菌（MRSE）和肠球菌等引起的重症感染的临床疗效好,但血药谷浓度高于最低抑菌浓度（MIC）时并不能进一步提高临床疗效,反而会引起肾功能损害,因此在使用过程中应密切监测血药谷浓度。Objective To investigate the correlation between the blood vancomycin peak concentration with the clinical effect and renal function to provide reference for personalized medication. Methods Totally 62 patients with infection admitted to our hospital from De-cember 2012 to January 2015 were selected and performed the blood vancomycin peak concentration monitoring. The clinical effect after treatment was evaluated;the renal function was detected at the regular intervals and the occurrence situation of adverse reactions was recorded. Results Among 62 cases of infection,44 cases（70. 97%） had the blood vancomycin peak concentration ≥10 mg/L,which reached the target values;the total effective rate was 83. 87%,the curative effective rates had no statistically significant differences a-mong 3 kinds of different peak concentration groups [﹤ 10 mg/L（group A）,10-15 mg/L（group B） and ﹥ 15 mg/L（group C）] . The occurrence rate of renal function damage in the group A was 11. 36%（5/44）,comparing the group C （﹥ 15 mg/L ） with the group A﹢B （﹥ 15 mg/L ） ,the renal toxicity in the former group was higher than that in the latter group by 4 times. Conclusion Vancomycin has better clinical effect for treating severe infection caused by methicillin-resistant Staphylococcus aureus（MRSA）,methicillin-resistant Staphylococcus epidermidis（MRSE）and enterococcus. But the blood drug peak concentration exceeding the minimal inhibitory concentra-tion（MIC） is unable to further increase the clinical effect,on the contrary could cause the renal function damage. Therefore the blood drug peak concentration should be closely monitored during the drug use process.

关 键 词：万古霉素 血药谷浓度 临床疗效 肾功能 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]