替考拉宁治疗儿童耐药革兰阳性球菌肺炎的量效关系  

Effect of exposure dosage of teicoplanin on clinical treatment of children with drug-resistant gram-positive cocci pneumonia

作　　者：高柳柳 石亮 李梦婷 康婷 梅艳[1] GAO Liu-liu;SHI Liang;LI Meng-ting;KANG Ting;MEI Yan(Wuhan Children's Hospital(Wuhan Maternal and Children Healthcare Hospital),Tongji Medical College,Huazhong University of Science&Technology,Wuhan,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院药学部,湖北武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院新生儿内科,湖北武汉430016

出　　处：《中华医院感染学杂志》2022年第11期1727-1731,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金青年基金资助项目(81600123);武汉市医学科研基金资助项目(WX21A14)。

摘　　要：目的考察耐药革兰阳性球菌感染肺炎儿童替考拉宁体内暴露量对临床疗效的影响。方法研究对象为华中科技大学同济医学院附属武汉儿童医院2016年2月-2020年11月使用替考拉宁治疗耐药革兰阳性球菌感染肺炎的患儿,获取和测定暴露量指标,包括日剂量、血清谷浓度(C_(min))和给药24 h内药-时曲线下面积(AUC_(0-24 h)),同时观察替考拉宁临床疗效。采用受试者工作特征曲线(ROC曲线)研究替考拉宁暴露量与临床疗效之间的关系。采用Logistic回归方程考察替考拉宁不同暴露水平下治疗儿童耐药革兰阳性球菌感染肺炎的成功概率。结果耐药革兰阳性球菌感染肺炎儿童使用替考拉宁治疗的总有效率为81.6%;AUC_(0-24 h)与临床疗效的关联性最强,ROC曲线下面积为0.877,最佳AUC_(0-24 h)界值切点为654.3 mg·h/L,表明AUC_(0-24 h)大于该值时治疗成功率较高。结论AUC_(0-24 h)是预测替考拉宁治疗儿童耐药革兰阳性球菌感染肺炎疗效的最佳暴露量参数,为保障有效性和安全性,临床应将AUC_(0-24 h)作为替考拉宁调整用药方案的依据。OBJECTIVE To research the relationship between the exposure dosage of teicoplanin and clinical effect in the treatment of children with pneumonia caused by drug-resistant gram-positive cocci.METHODS A total of 136 children with pneumonia caused by drug-resistant gram-positive cocci treated with teicoplanin in Wuhan Children′s hospital from Feb.2016 to Nov.2020 were enrolled in our research.The exposure indexes such as daily dose,serum minimum concentration(C_(min))and the area under the drug concentration-time curve in a 24 h interval(AUC_(0-24 h))were determined and the clinical efficacy of teicoplanin was observed.The correlation between the exposure of teicoplanin and the clinical efficacy was evaluated by receiver operating characteristic(ROC)curve analysis.The effective probability of teicoplanin in treating children with pneumonia caused by drug-resistant gram-positive cocci at different exposure levels was evaluated by Logistic regression equation.RESULTS The effective probability of teicoplanin for the treatment of pneumonia caused by drug-resistant gram-positive cocci in children was 81.6%.AUC_(0-24 h)was closely associated with the clinical efficacy,and the area under the ROC curve was 0.877.The cut-off value was 654.3 mg·h/L,which suggested that the effective probability would be higher when AUC_(0-24 h)was larger than 654.3 mg·h/L.CONCLUSION AUC_(0-24 h)is the optimal parameter for the prediction of teicoplanin efficacy in the treatment of pneumonia caused by drug-resistant gram-positive cocci in children.It is necessary for doctors to adjust the dosing regimens based on the value of AUC_(0-24 h)in order to ensure the effectiveness and safety of teicoplanin.

关 键 词：替考拉宁 耐药革兰阳性球菌感染肺炎 儿童 暴露量 疗效 

分 类 号：R563[医药卫生—呼吸系统]