多黏菌素B相关急性肾损伤的危险因素分析  

Risk factors for polymyxin B related acute kidney injury

作　　者：王清[1,2] 李颖[1,2] 唐甜甜[1,2] 颜晗[1,2] 蔡骅琳 向大雄[1,2] 张毕奎[1,2] 周艳钢[1,2] 徐萍[1,2] WANG Qing;LI Ying;TANG Tian-tian;YAN Han;CAI Hua-lin;XIANG Da-xiong;ZHANG Bi-kui;ZHOU Yan-gang;XU Ping(Department of Pharmacy,The Second Xiangya Hospital of Central South University,Changsha 410011;Institute of Clinical Pharmacy,Central South University,Changsha 410011)

机构地区：[1]中南大学湘雅二医院药学部,长沙410011 [2]中南大学临床药学研究所,长沙410011

出　　处：《中南药学》2024年第11期3096-3102,共7页Central South Pharmacy

摘　　要：目的探讨多黏菌素B相关急性肾损伤(AKI)的危险因素,为多黏菌素B的安全应用提供参考。方法收集2017年12月至2022年4月住院患者中静脉用多黏菌素B治疗≥3 d的病例,采用RIFLE标准判断AKI及严重程度分级,Logistic回归分析多黏菌素B相关AKI的危险因素。结果研究期间共纳入441例患者,其中,111例(25.2%)患者发生AKI,67例(60.4%)为危险分级,28例(25.2%)为损伤分级,16例(14.4%)为衰竭分级。合并慢性肾病(OR 2.13,95%CI 1.16~3.90,P=0.014)、合用血管活性药物(OR 2.59,95%CI 1.59~4.20,P<0.001)或替加环素(OR 2.02,95%CI 1.26~3.25,P=0.004)与AKI的发生显著相关。多黏菌素B血药浓度指标中,仅Cmin是AKI发生的独立危险因素(OR 2.09,95%CI 1.38~3.19,P=0.001),当Cmin≥4.07μg·mL^(-1)时,AKI发生的预测概率>50%。结论合并慢性肾病、合用血管活性药物或替加环素、多黏菌素B的Cmin与AKI发生密切相关。多黏菌素B的Cmin对其相关AKI具有较好的预测价值,阈值为4.07μg·mL^(-1)。Objective To determine the risk factors of polymyxin B related acute kidney injury(AKI).Methods Patients receiving≥3 days of polymyxin B treatment from December 2017 to April 2022 were included.AKI and AKI severity were evaluated with RIFLE criteria.Logistic regression analysis was performed to identify the risk factors of polymyxin B related AKI.Results Totally 441 patients were included.Among them,111 patients(25.2%)developed AKI,67(60.4%)patients were classified as having risks,28(25.2%)injury and 16(14.4%)failure.The co-morbidity of chronic renal disease(OR 2.13,95%CI 1.16~3.90,P=0.014),combination with vasoactive agents(OR 2.59,95%CI 1.59~4.20,P<0.001),and tigecycline(OR 2.02,95%CI 1.26~3.25,P=0.004)was obviously related with AKI.Cmin was the independent risk factor of AKI among exposure indicators(OR 2.09,95%CI 1.38~3.19,P=0.001).The estimated probability of AKI was higher than 50%when Cmin was higher than 4.07μg·mL^(-1).Conclusion Co-morbidity of chronic renal disease,combination with vasoactive agents or tigecycline,Cmin of polymyxin B are closely related to polymyxin B induced AKI.Cmin has good predictive value,with the threshold of 4.07μg·mL^(-1).

关 键 词：多黏菌素B 急性肾损伤 危险因素 谷浓度 

分 类 号：R969[医药卫生—药理学]