血液病患者万古霉素血药浓度特点及影响因素  

Clinical Characteristics and Influencing Factors of Vancomycin Blood Concentration in Patients with Hematologic Disease

作　　者：夏凡[1] 黄春燕[1] 谢诚[1] 苗瞄[2] 朱建国[1] 刘林生[1] XIA Fan;HUANG Chunyan;XIE Chen;MIAO Miao;ZHU Jianguo;LIU Linsheng(Department of Pharmacy,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Department of Hematology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院药学部,苏州215006 [2]苏州大学附属第一医院血液内科,苏州215006

出　　处：《医药导报》2023年第5期738-741,共4页Herald of Medicine

摘　　要：目的 分析常规给药剂量下血液病患者万古霉素血药浓度及影响万古霉素体内暴露水平的相关因素。方法 回顾性分析2018年1月—2021年8月就诊于苏州大学附属第一医院的血液病患者85例,均使用万古霉素1.0 g,静脉滴注,q12h,监测稳态血药浓度,根据血药浓度达标情况进行分组并采用单因素分析和Logistic回归考察其影响因素。结果 85例患者平均血药浓度(8.35±3.89) mg·L^(-1),达标率仅27.1%(23/85)。单因素分析显示,达标组患者血清肌酐和外周血中性粒细胞绝对计数(ANC)水平均显著高于未达标组[(61.47±19.68)μmol·L^(-1)vs.(53.30±14.66)μmol·L^(-1),P=0.041;0.65×10^(9)·L^(-1)vs. 0.02×10^(9)·L^(-1),P=0.032],肌酐清除率及肾功能亢进比例则显著降低[(125.17±38.56) mL·min^(-1)vs.(162.06±44.25) mL·min^(-1),P=0.001;34.8%(8/23)vs. 72.6%(45/62),P=0.001]。多重线性回归显示仅ANC差异有统计学意义(P=0.010)。进一步分析发现万古霉素的低暴露与ANC减少有关,而与减少的程度无关。结论 中性粒细胞减少可能是血液病患者万古霉素血药浓度偏低的主要原因之一,制定初始给药方案时应考虑该因素的影响。Objective To analyze the clinical characteristics of blood concentration of vancomycin at the conventional dosage in patients with hematological diseases and explore the related factors which affect the exposure level of vancomycin in patients with hematological diseases.Methods A retrospective analysis was performed on 85 patients with hematological diseases treated with vancomycin(1.0 g,ivgtt,q12h)and monitored blood concentration of vancomycin from January 2018 to August 2021 in our hospital.These patients were divided into two groups according to the blood concentration of vancomycin achievement and the related influencing factors explored by single-factor analysis and logistic multivariate regression analysis.Results The mean blood concentration of vancomycin was(8.35±3.89)mg·L^(-1),and the compliance rate was only 27.1%(23/85)in 85 patients.The results of single factor analysis showed the levels of blood creatinine and absolute neutrophil count(ANC)were significantly higher in the achievement group than those in the non-achievement group[(61.47±19.68)μmol·L^(-1) vs.(53.30±14.66)μmol·L^(-1),P=0.041;0.65×10^(9)·L^(-1) vs.0.02×10^(9)·L^(-1),P=0.032],but the endogenous creatinine clearance rate and the rate of augmented renal clearance were lower significant[(125.17±38.56)mL·min^(-1) vs.(162.06±44.25)mL·min^(-1),P=0.001;34.8%(8/23)vs.72.6%(45/62),P=0.001].Multiple linear regression analysis showed that only ANC had a significant effect(P=0.010).Further analysis found that low vancomycin exposure was related to the ANC reduction,but not the degree of ANC reduction.Conclusion Neutropenia may be one of the main reasons for the low blood concentration of vancomycin in patients with hematological diseases.The influence of this factor should be considered when developing the initial dosing regimen for such patients.

关 键 词：万古霉素 血药浓度 血液病 中性粒细胞缺乏 

分 类 号：R978.1[医药卫生—药品] R969.3[医药卫生—药学]