静脉滴注万古霉素致中国人群急性肾损伤危险因素的系统评价  

Systematic Evaluation of Risk Factors for Intravenous Dripping of Vancomycin-induced Acute Kidney Injury in Chinese Patients

作　　者：毛婷[1] 李吉莹[1] 王胜红[1] 孙凯[2] 江华[2] 李晶晶[3] MAO Ting;LI Jiying;WANG Shenghong;SUN Kai;JIANG Hua;LI Jingjing(College of BiologicalMedicine,Changiang Vocational College,Wuhan 430000,Chin;Dept.of Clinical Laboratory,XiangyangCentral Hospital/the Affiliated Hospital of Hubei Arts and Sciences,Wuhan 430060,China;Dept.of Pharmacy,Hubei University of TCM,Wuhan 430065,China)

机构地区：[1]长江职业学院生物医药学院,武汉430000 [2]襄阳市中心医院/湖北文理学院附属医院检验科,武汉430060 [3]湖北中医药大学药学系,武汉430065

出　　处：《中国药房》2018年第13期1836-1840,共5页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81641188);湖北省自然科学基金项目(No.2012FFA071)

摘　　要：目的:系统评价静脉滴注万古霉素致中国人群急性肾损伤的危险因素。方法:计算机检索建库起至2017年12月发表于Pub Med、Embase、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库、中国生物医学数据库、万方等相关数据库中有关静脉滴注万古霉素致中国人群急性肾损伤危险因素的病例对照研究,对符合纳入标准的文献进行资料提取,并采用纽卡斯尔-渥太华质量评估量表(NOS)对纳入文献进行质量评价后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入11项研究,合计1 378例患者,涉及20个相关因素,其中11个因素差异有统计学意义(P<0.05):患者基本情况,包括体质量偏低[MD=-2.19,95%CI(-4.03,-0.35),P=0.020],入住重症监护治疗病房(ICU)[OR=2.52,95%CI(1.33,4.78),P=0.005],肌酐清除率偏低[MD=-17.43,95%CI(-20.76,-14.10),P<0.001]、急性生理和慢性健康评分Ⅱ(APACHE-Ⅱ)评分偏高[MD=4.13,95%CI(2.44,5.82),P<0.001];合并基础疾病,包括呼吸衰竭[OR=4.07,95%CI(2.59,6.40),P<0.001]、严重心血管疾病[OR=2.01,95%CI(1.34,3.02),P=0.007];联合用药,包括利尿药[OR=2.97,95%CI(2.15,4.11),P<0.001]、血管升压药[OR=4.48,95%CI(2.63,7.62),P<0.001],血管紧张素转换酶抑制药或血管紧张素Ⅱ受体阻断药[OR=1.84,95%CI(1.17,2.90),P=0.009];万古霉素用药情况,包括用药时间偏长[MD=2.03,95%CI(0.90,3.15),P=0.004]和谷浓度偏高[MD=8.11,95%CI(5.38,10.85),P<0.001]。结论:患者体质量偏低、入住ICU、用药前肌酐清除率偏低、APACHE-Ⅱ评分偏高、呼吸衰竭、合并利尿剂或血管升压药等、万古霉素用药时间偏长和谷浓度偏高是万古霉素致急性肾损伤的危险因素,患者存在上述情况时应谨慎用药,关注急性肾损伤的发生。OBJECTIVE：To evaluate the risk factors for intravenous dripping of vancomycin-induced acute kidney injury（AKI）in Chinese patients. METHODS：The case-control studies about risk factors for intravenous dripping of vancomycin-induced AKI were retrieved from Pub Med, Embase, Cochrane library, CNKI, VIP, CBM and Wanfang database during database establishment to Dec. 2017. The data of included literatures was extracted. After quality evaluation was carried out with Newcastle Ottawa quality assessment scale,Meta-analysis was conducted by using Rev Man 5.2 software. RESULTS：A total of 11 studies were included,involving 1 378 patients. 20 risk factors were involved,11 of which were significantly different（P〈0.05）. General information of patients included low body weight [MD=-2.19,95% CI（-4.03,-0.35）,P=0.020],intensive care unit（ICU）admission [OR=2.52,95%CI（1.33,4.78）,P=0.005],low creatinine clearance rate [MD=-17.43,95%CI（-20.76,-14.10）,P〈0.001],high acute physiological and chronic health score Ⅱ（APACHE-Ⅱ）score [MD=4.13,95% CI（2.44,5.82）,P〈0.001];combined primary diseases included respiratory failure [OR=4.07,95% CI=2.59,6.40,P〈0.001] and severe cardiovascular disease [OR=2.01,95% CI（1.34,3.02）,P=0.007];drug combination included diuretic [OR=2.97,95% CI（2.15,4.11）,P〈0.001],vasopressor agent [OR=4.48,95%CI（2.63,7.62）,P〈0.001] and ACEI or ARB [OR=1.84,95%CI（1.17,2.90）,P=0.009];vancomycin use included long medication time [MD=2.03,95%CI（0.90,3.15）,P=0.004] and high trough concentration[MD=8.11,95%CI（5.38,10.85）,P〈0.001]. CONCLUSIONS：Low body weight,ICU admission,low creatinine clearance rate,high APACHE-Ⅱ score,respiratory failure,combined with diuretics or vasopressors agent,long medication time and high trough concentration are the risk factors for vancomycininduced AKI.

关 键 词：万古霉素 急性肾损伤 危险因素 中国人群 META分析 

分 类 号：R978.1[医药卫生—药品]