成年患者万古霉素相关肾毒性危险因素的Meta分析  

Meta-analysis of risk factors for vancomycin-related nephrotoxicity in adult patients

作　　者：李若茗 陈超阳[1,4] 马凌云 周双[1,4] 郑茜子[2] 周颖[1,4] 崔一民[1,3,4] 杨莉[2] LI Ruo-ming;CHEN Chao-yang;MA Ling-yun;ZHOU Shuang;ZHENG Xi-zi;ZHOU Ying;CUI Yi-min;YANG Li(Department of Pharmacy,Peking University First Hospital,Beijing 100034,China;Department of Nephrology,Peking University First Hospital,Beijing 100034,China;Institute of Clinical Pharmacology,Peking University First Hospital,Beijing 100034,China;Department of Pharmacy Administration and Clinical Pharmacy,School of Pharmaceutical Sciences,Peking University Health Science Center,Bejing 100191,China)

机构地区：[1]北京大学第一医院药学部,北京100034 [2]北京大学第一医院肾内科,北京100034 [3]北京大学第一医院临床药理研究所,北京100034 [4]北京大学医学部药学院药事管理与临床药学系,北京100191

出　　处：《中国临床药理学杂志》2022年第18期2214-2219,共6页The Chinese Journal of Clinical Pharmacology

基　　金：国家药品监督管理局中国药品监管科学研究行动计划重点基金资助项目(CDRZ201930)。

摘　　要：目的分析成年患者使用万古霉素相关肾毒性(VAN)的危险因素。方法系统检索PubMed、Embase、Cochrane Library、中国知网、万方数据库和维普网,检索时间为2011-01-01至2021-03-22,按照预定的标准纳入通过多因素回归分析报告万古霉素危险因素的比值比(OR)和95%可信区间(CI)的研究并进行数据提取。采用Stata 15.0软件进行Meta分析。结果纳入49篇研究,共14271例患者。较高的万古霉素谷浓度(≥20μg·mL^(-1))[OR=4.64,95%CI=2.22~9.74,P<0.01]、更长的治疗时间(≥14 d)[OR=1.91,95%CI=1.45~2.51,P<0.01]、收入重症监护室治疗[OR=1.98,95%CI=1.36~2.89,P<0.01]和合用肾毒性药物[OR=1.82,95%CI=1.22~2.71,P<0.01]与VAN风险增加显著相关。结论较高的万古霉素谷浓度水平、长期治疗、病情危重和合用肾毒性药物可能与VAN的发生发展相关。Objective To analyze the risk factors of vancomycin-associated nephrotoxicity(VAN)in adult patients.Methods A systematic search of PubMed,Embase,Cochrane Library,CNKI,Wanfang database and VIP database was conducted from January 1,2011 to March 22,2021.The odds ratio(OR)and 95%confidence interval(95%CI)of vancomycin risk factors reported by multivariate regression analysis were included according to predetermined criteria and data were extracted.Meta-analysis was performed using Stata 15.0 software.Results Forty-nine studies with a total of 14271 patients were included.Higher trough concentration of vancomycin(≥20μg·mL^(-1))[OR=4.64,95%CI=2.22-9.74,P<0.01],longer treatment duration(≥14 days)[OR=1.91,95%CI=1.45-2.51,P<0.01],hospitalization in intensive care unit[OR=1.98,95%CI=1.36-2.89,P<0.01]and combined treatment with diuretics[OR=1.82,95%CI=1.22-2.71,P<0.01]were significantly associated with an increased risk of VAN.Conclusion Higher vancomycin trough concentration,long-term treatment,critical condition and combined use of nephrotoxic drugs may be related to the occurrence and development of VAN.

关 键 词：万古霉素 肾毒性 肾损伤 系统评价 META分析 

分 类 号：R97[医药卫生—药品]