万古霉素血药浓度测定在腹膜透析相关性腹膜炎患者治疗中的作用  

Role of vancomycin plasma concentration determination in treating patients with peritoneal-dialysis-related peritonitis

作　　者：叶寅寅[1] 周茹 宋霞 杨沿浪[1] 汪裕伟[1] Ye Yinyin;Zhou Ru;Song Xia;Yang Yanlang;Wang Yuwei(Department of Nephrology,Yijishan Hospital of Wannan Medical College)

机构地区：[1]皖南医学院附属弋矶山医院肾内科,芜湖241001

出　　处：《重庆医科大学学报》2021年第3期350-354,共5页Journal of Chongqing Medical University

基　　金：皖南医学院重点科研资助项目(编号:WK2018ZF05)。

摘　　要：目的:研究万古霉素血药浓度测定在腹膜透析相关性腹膜炎患者治疗中的作用,为腹膜炎的治疗提供更多理论依据。方法:收集皖南医学院弋矶山医院2016年1月1日至2018年12月31日腹膜透析相关性腹膜炎患者的临床资料进行回顾性分析,按照万古霉素血药浓度将患者分成低浓度组(<15μg/mL)和高浓度组(≥15μg/mL),分析2组患者性别、发病特征、年龄、透析龄、各项常规生化检测指标,以及尿量、腹膜透析退出率、体质指数、住院日的差异,logistic回归分析影响万古霉素血药浓度的因素。结果:近3年共发生106例次腹膜透析相关性腹膜炎,平均腹膜炎发生率为0.19次/风险年。透出液致病菌培养阳性共72例次(67.92%),其中革兰阳性菌39株(54.17%),革兰阳性菌中表皮葡萄球菌与金黄色葡萄球菌最常见,且均对万古霉素敏感。万古霉素低浓度组与高浓度组间体质指数、尿量、住院日存在明显差异。Logistic回归分析提示低密度脂蛋白(OR=2.240,P=0.038)、体质指数(OR=1.981,P<0.001)、尿量(OR=13.749,P=0.010)是影响万古霉素浓度的主要因素。结论:万古霉素血药浓度测定为腹膜炎治疗提供更加合理的用药方案,具有重要的指导意义。Objective:To study the role of vancomycin plasma concentration determination in treating patients with peritoneal-dialysisrelated peritonitis,so as to provide theoretical basis for peritonitis treatment. Methods:Clinical data of patients with peritoneal-dialysisrelated peritonitis from January 1,2016 to December 31,2018 in our hospital were collected and retrospectively analyzed. Patients were divided into the low concentration group(<15 μg/mL)and the high concentration group (≥15 μg/mL)according to the blood concentration of vancomycin. Differences in gender,onset characteristics,age,dialysis age,various routine biochemical indicators,urine volume,dropout rate,body mass index(BMI)and hospitalization day between two groups were analyzed. Factors influencing the blood concentration of vancomycin were detcetd by logistic regression analysis. Results:A total of 106 cases of peritoneal dialysisrelated peritonitis occurred in the last three years,with an average incidence of 0.19 times/year. Among them,72 cases(67.92%)were positive for bacteria culture of permeable bacteria,among which 39 strains(54.17%)were gram-positive bacteria. Among the grampositive bacteria,Staphylococcus epidermidis and Staphylococcus aureus were the most common,and were sensitive to vancomycin.BMI,urine volume,and hospitalization time between two groups had significant differences. Logistic regression analysis showed that low-density lipoprotein(OR=2.240,P=0.038),BMI(OR=1.981,P<0.001)and urine volume(OR=13.749,P=0.010) were the main factors affecting vancomycin concentration. Conclusion:The determination of vancomycin plasma concentration is of great clinical significance to provide a more reasonable drug regimen for treating peritoneal-dialysis-related peritonitis.

关 键 词：万古霉素 腹膜透析 腹膜炎 

分 类 号：R459.5[医药卫生—治疗学]