两性霉素B脂质体治疗侵袭性真菌感染病人发生急性肾损伤危险因素分析  

Analysis of risk factors for acute kidney injury in patients with invasive fungal infection treated with liposomal amphotericin B

作　　者：陈丽娟[1] 朱蕻潮 吴晓丽[1] 杨康群[1] 秦海艳 王昕雯[1] CHEN Lijuan;ZHU Hongchao;WU Xiaoli;YANG Kangqun;QIN Haiyan;WANG Xinwen(Department of Pharmacy,The Affiliated Huai'an NO.1 People's Hospital of Nanjing Medical University,Huai'an,Jiangsu 223300,China;Department of Nuclear Medicine,The Affiliated Huai'an NO.1 People's Hospital of Nanjing Medical University,Huai'an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院药学部,江苏淮安223300 [2]南京医科大学附属淮安第一医院核医学科,江苏淮安223300

出　　处：《安徽医药》2024年第6期1263-1268,共6页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省药学会-奥赛康医院药学基金(A202143)。

摘　　要：目的研究两性霉素B脂质体(L-AMB)治疗侵袭性真菌感染病人发生急性肾损伤(AKI)的危险因素。方法回顾性分析南京医科大学附属淮安第一医院2018年1月至2021年12月61例两性霉素B脂质体治疗侵袭性真菌感染病人的临床资料,根据是否发生两性霉素B脂质体相关AKI分为AKI组23例(37.7%),非AKI组38例(62.3%)。采用单因素分析法比较两组临床资料,logistic回归分析两性霉素B脂质体(L-AMB)治疗侵袭性真菌感染病人发生AKI的危险因素,应用受试者操作特征曲线(ROC曲线)评价L-AMB使用累积剂量及治疗前血清钾水平在诊断AKI方面的能力。结果有23例病人在使用L-AMB治疗过程中发生AKI,AKI发生率为37.7%。L-AMB疗程、累积剂量、日剂量,L-AMB治疗前血钾水平在AKI及非AKI两组病人比较中均差异有统计学意义(均P<0.05);累积剂量是发生L-AMB相关AKI的独立危险因素[OR=1.46,95%CI:(1.08,1.98),P=0.014];在L-AMB治疗前低血钾水平是发生L-AMB相关AKI的另一个独立危险因素[OR=0.05,95%CI:(0.01,0.43),P=0.007]。累积剂量和治疗前血钾水平曲线下面积(AUC)及其95%CI分别为0.88(0.79,0.98)、0.88(0.79,0.96),灵敏度分别为86.9%、81.5%,特异度分别为89.4%、86.9%。结论L-AMB累积剂量及治疗前低血钾水平均是L-AMB相关AKI的独立危险因素,两者在L-AMB相关AKI的诊断中均有一定的预测价值,而且累积剂量的诊断价值大于治疗前低血钾水平。Objective To investigate the risk factors for acute kidney injury(AKI)in patients with invasive fungal infection treated with liposomal amphotericin B(L-AMB).Methods The clinical data of 61 patients with invasive fungal infection treated with amphotericin B liposome from January 2018 to December 2021 in the Affiliated Huaian NO.1 People's Hospital of NanJing Medical University were analyzed retrospectively.According to the incidence of acute renal injury associated with liposomal amphotericin B,23 patients(37.7%)were in AKI group and 38 patients(62.3%)were in non-AKI group.The clinical data of the two groups were compared by single factor analysis,the logistic regression was used to analyze the risk factors of acute renal injury in patients with invasive fungal infection treated with L-AMB,and receiver operating characteristic curve was used to evaluate the cumulative dose of L-AMB and the ability of serum potassium levels in the diagnosis of AKI before treatment.Results Twenty-three patients developed AKI during treatment with L-AMB,and the incidence rate was 37.7%.Before the treatment of L-AMB,there were significant differences in the treatment course,cumulative dose,daily dose and serum potassium levels between AKI patients and non-AKI patients(all P<0.05).Cumulative dose was an independent risk factor for L-AMB-related AKI[OR=1.46,95%CI:(1.08,1.98),P=0.014];Hypokalemia before L-AMB treatment was another independent risk factor for acute renal injury associated with L-AMB[OR=0.05,95%CI:(0.01,0.43),P=0.007].The area under the curve(AUC)of the cumulative dose and serum potassium level before treatment were 0.88(0.79,0.98)and 0.88(0.79,0.96),respectively.The sensitivity was 86.9%and 81.5%,and the specificity was 89.4%and 86.9%,respectively.Conclusions The cumulative dose of L-AMB and the level of hypokalemia before treatment are independent risk factors for L-AMB-related AKI.Both have certain predictive value in the diagnosis of L-AMB-related acute renal injury,and the diagnostic value of cumulative doses is grea

关 键 词：两性霉素B脂质体 侵袭性真菌感染 急性肾损伤 药物毒性 危险因素 

分 类 号：R519[医药卫生—内科学] R692[医药卫生—临床医学]