替考拉宁在老年人群中谷浓度的监测及其达标率的影响因素  

Exploring the results and influencing factors of minimum concentration of teicoplanin in elderly population

作　　者：岑菁 高倩 刘睿翔 马攀 CEN Jing;GAO Qian;LIU Ruixiang;MA Pan(Department of Pharmacy,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院药学部,重庆400038

出　　处：《中国临床药学杂志》2024年第8期615-619,共5页Chinese Journal of Clinical Pharmacy

基　　金：重庆市科卫联合医学科研项目(编号2023QNXM031)。

摘　　要：目的监测老年患者替考拉宁谷浓度(cmin)水平及达标情况,并探讨老年患者cmin达标的影响因素,为老年患者合理使用替考拉宁提供参考。方法回顾性收集2017年11月至2022年7月使用替考拉宁治疗的老年感染患者。分析老年患者替考拉宁cmin的分布情况。将患者性别、年龄、身高、体质量、初始负荷剂量、血清白蛋白(ALB)、尿素、肌酐清除率(Ccr)、胱抑素C、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、总胆红素(TBIL)和急性生理与慢性健康评分(APACHE)Ⅱ评分纳入单因素和多重线性回归分析,探讨影响替考拉宁cmin达标的相关因素。结果83例老年患者监测替考拉宁cmin共129例次,cmin为(17.76±9.59)mg·L^(-1),其中88例次(占68.22%)达到目标浓度(10~30 mg·L^(-1)),26例次(占20.16%)未达标(<10 mg·L^(-1)),15例次(占11.63%)超标(>30 mg·L^(-1))。多重线性回归分析结果显示,性别(B=-3.130,95%CI=-6.219~-0.042,P<0.05),初始负荷给药剂量(B=31.251,95%CI=23.868~38.634,P<0.01),Ccr(B=-0.064,95%CI=-0.105~-0.023,P<0.01),以及总胆红素(B=-0.045,95%CI=-0.081~-0.009,P<0.05)是影响老年患者替考拉宁cmin的主要相关因素。结论老年患者替考拉宁cmin个体差异大,在优化替考拉宁给药方案时应考虑初始负荷给药剂量、Ccr和总胆红素水平因素的影响。AIM To explore the influencing factors of achieving target teicoplanin trough concentrations(c_(min))in elderly patients by monitoring their c_(min)levels,providing reference for the rational use of teicoplanin in elderly patients.METHODS A retrospective analysis was performed on elderly patients who were treated with teicoplanin,and serum concentration of teicoplanin was monitored from November 2017 to July 2022.The distribution of teicoplanin c_(min)in elderly patients were collected.Various patient parameters were incorporated into both univariate and multivariate linear regression analyses to explore the related factors affecting the standard of teicoplanin c_(min).The parameters included the patient's gender,age,height,body weight,initial loading dose of teicoplanin,serum albumin(ALB)levels,urea levels,creatinine clearance rate(Ccr),cystatin C levels,alanine aminotransferase(ALT)levels,aspartate aminotransferase(AST)levels,gamma-glutamyl transferase(GGT)levels,alkaline phosphatase(ALP)levels,total bilirubin(TBIL)levels,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score.RESULTS A total of 129 samples of teicoplanin c_(min)in 83 elderly patients were enrolled,and it was found that 88 samples(68.22%)reached the target concentration(10-30mg·L^(-1)),26 samples(20.16%)<10 mg·L^(-1)and 15 samples(11.63%)>30 mg·L^(-1).Multiple linear regression analysis revealed that gender(B=-3.130,95%CI=-6.219--0.042,P<0.05),the initial loading dosage of teicoplanin(B=31.251,95%CI=23.868-38.634,P<0.01),Ccr(B=-0.064,95%CI=-0.105--0.023,P<0.01),and the level of TBIL(B=-0.045,95%CI=-0.08--0.009,P<0.05)were correlated with the teicoplanin c_(min)in elderly patients.CONCLUSION The individual difference of teicoplanin c_(min)in elderly patients is large,and the influence of initial loading dose,Ccr and total bilirubin level should be considered when optimizing the dosage regimen of teicoplanin.

关 键 词：替考拉宁 老年患者 谷浓度 负荷剂量 肌酐清除率 影响因素 

分 类 号：R969[医药卫生—药理学]