危重患者多黏菌素B药物浓度与多黏菌素B相关性急性肾损伤相关性研究  

Correlation between polymyxin B concentration and polymyxin B associated acute kidney injury in critically ill patients

作　　者：张鑫 钱倩 周国平 安宗仁 孙文逵 ZHANG Xin;QIAN Qian;ZHOU Gouping;AN Zongren;SUN Wenkui(Nanjing Gaochun People's Hospital,Nanjing Jiangsu 210029,China)

机构地区：[1]南京高淳人民医院,江苏南京210029 [2]南京医科大学第一附属医院,江苏南京210029

出　　处：《中国急救复苏与灾害医学杂志》2024年第12期1580-1583,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委员会面上项目(编号:JSHD2022048)。

摘　　要：目的探讨危重患者多黏菌素B(PMB)药物浓度与PMB相关性急性肾损伤的相关性。方法回顾性分析本院2021年8月—2023年7月间收治的120例接受静脉注射PMB治疗的重症患者的临床资料,根据是否发生PMB相关性急性肾损伤分为急性肾损伤组和非急性肾损伤组。比较两组患者临床资料,采用单因素和多因素Logistic回归分析重症患者发生PMB相关性急性肾损伤的危险因素。绘制受试者工作特征(ROC)曲线分析PMB药物浓度参数预测危重患者PMB相关性急性肾损伤发生的效能。结果120例危重患者中有33例(27.50%)确诊为PMB相关性急性肾损伤。急性肾损伤组患者万古霉素应用比例、C_(1/2)、C_(min)显著大于非急性肾损伤组(P<0.05)。Logistic回归分析结果表明,C_(1/2)、C_(min)是重症患者发生PMB相关性肾损伤的独立危险因素(P<0.05)。ROC曲线结果显示,C_(1/2)的AUC为0.798(95%CI:0.695~0.901),最佳截断值为3.421 mg/L,对应的灵敏度、特异度和约登指数分别为60.61%、89.65%和0.5026。C_(min)的AUC为0.676(95%CI:0.558~0.795),最佳截断值为2.284 mg/L,对应的灵敏度、特异度和约登指数分别为66.67%、73.56%和0.4023。结论危重患者PMB相关性急性肾损伤发生与PMB药物浓度相关,C_(1/2)、C_(min)可作为PMB治疗期间发生PMB相关性急性肾损伤的预测指标。Objective To investigate the correlation between Polymyxin B(PMB)concentration and PMB related acute kidney injury in critically ill patients.Methods The clinical data of 120 severe patients treated with intravenous PMB from August 2021 to July 2023 in our hospital were retrospectively analyzed,and they were divided into acute renal injury group and non-acute renal injury group according to whether PMB related acute renal injury occurred.The clinical data of the two groups were compared,and the risk factors of PMB-related acute kidney injury in severe patients were analyzed by univariate and multivariate Logistic regression.Receiver Operating Characteristic(ROC)curves were drawn to analyze the efficacy of PMB drug concentration parameters in predicting the occurrence of PMB-associated acute kidney injury in critically ill patients.Results Among 120 critically ill patients,33(27.50%)were diagnosed with PMB-associated acute kidney injury.Vancomycin application ratio,C_(1/2)and C_(min)in acute renal injury group were significantly higher than those in non-acute renal injury group(P<0.05).Logistic regression analysis showed that C_(1/2)and C_(min)were independent risk factors for PMB-related kidney injury in severe patients(P<0.05).ROC curve results showed that the AUC of C_(1/2)was 0.798(95%CI:0.695-0.901),the best diagnostic value was 3.421 mg/L,and the corresponding sensitivity,specificity and Jorden index were 60.61%,89.65%and 0.5026,respectively.The AUC of Cminwas 0.676(95%CI:0.558-0.795),the best diagnostic value was 2.284 mg/L,and the corresponding sensitivity,specificity and Jorden index were 66.67%,73.56%and 0.4023,respectively.Conclusion The occurrence of PMB associated acute kidney injury in critically ill patients is related to the concentration of PMB,and C_(1/2)and C_(min)can be used as predictors of the occurrence of PMB-associated acute kidney injury during PMB treatment.

关 键 词：多黏菌素B 危重患者 药物浓度 急性肾损伤 危险因素 相关性 

分 类 号：R969.3[医药卫生—药理学] R692.5[医药卫生—药学]