儿童患者万古霉素稳态血药浓度谷值与AUC_(24)/MIC的相关性及治疗失败的危险因素分析  

Correlation of the steady-state minimal concentration with AUC_(24)/MIC of vancomycin and analysis of risk factors for treatment failure in pediatric patients

作　　者：林金香 王幼鸿 肖智锋 王晶 宋颖 蔡凝芳 吴秀萍 LIN Jinxiang;WANG Youhong;XIAO Zhifeng;WANG Jing;SONG Ying;CAI Ningfang;WU Xiuping(Dept.of Pharmacy,Xiamen Children’s Hospital/Children’s Hospital of Fudan University at Xiamen,Fujian Xiamen 361006,China)

机构地区：[1]厦门市儿童医院/复旦大学附属儿科医院厦门医院药学部,福建厦门361006

出　　处：《中国药房》2025年第9期1093-1098,共6页China Pharmacy

基　　金：国家自然科学基金-青年科学基金项目(No.82204535);厦门市科技计划项目(No.3502Z20227145,No.3502Z202372098);厦门市医疗卫生指导性项目(No.3502Z20224ZD1269)。

摘　　要：目的评估儿童患者万古霉素稳态血药浓度谷值(c_(min))与24 h药时曲线下面积(AUC_(24))/最小抑菌浓度(MIC)比值(AUC_(24)/MIC)的相关性,并分析万古霉素治疗失败的独立危险因素。方法回顾性收集2021年1月至2024年7月于我院使用万古霉素治疗且进行治疗药物监测的住院患儿资料,按治疗是否成功分为成功组和失败组。采用Spearman相关性分析评估万古霉素c_(min)与AUC_(24)/MIC的相关性,采用单因素及多因素Logistic回归分析筛选万古霉素治疗失败的独立危险因素。结果共纳入59例患儿,成功组41例、失败组18例。与失败组比较,成功组患儿的万古霉素AUC_(24)/MIC显著升高(P=0.038);但两组患儿的c_(min)比较,差异无统计学意义(P>0.05)。万古霉素的c_(min)与AUC_(24)/MIC呈显著正相关(r=0.499,P<0.001),但其对AUC_(24)/MIC达标(≥400)有一定的预测效能(受试者操作特征曲线下面积=0.696),Youden指数确定的最佳截断值为6.05 mg/L。AUC_(24)/MIC预测治疗失败的效能优于c_(min)(受试者操作特征曲线下面积为0.671 vs.0.523,P为0.038 vs.0.684),敏感性更高(83.3%vs.66.7%)。低蛋白血症和AUC_(24)/MIC≤369.1是导致万古霉素治疗失败的独立危险因素(P<0.05)。患儿肾毒性发生率为3.4%。结论儿童患者万古霉素的c_(min)与AUC_(24)/MIC呈显著正相关;低蛋白血症和AUC_(24)/MIC≤369.1是导致患儿万古霉素治疗失败的独立危险因素。OBJECTIVE To assess the correlation between the steady-state minimal concentration(c_(min))and 24 h area under the drug concentration-time curve(AUC_(24))/minimal inhibitory concentration(MIC)ratio(AUC_(24)/MIC)of vancomycin in pediatric patients,and analyze independent risk factors for treatment failure.METHODS Data of hospitalized children treated with vancomycin and receiving therapeutic drug monitoring in our hospital from January 2021 to July 2024 were retrospectively collected and divided into success group and failure group according to whether the treatment was successful or not.Spearman correlation analysis was used to analyze the correlation between c_(min)and AUC_(24)/MIC of vancomycin,and one-way and multifactorial Logistic regression analyses were used to screen the independent risk factors for vancomycin treatment failure.RESULTS A total of 59 children were included,with 41 in the success group and 18 in the failure group.Compared with the failure group,AUC_(24)/MIC of vancomycin was significantly higher in the success group(P=0.038),but there was no statistically significant difference in the c_(min)of the two groups(P>0.05);c_(min)of vancomycin was significantly positively correlated with AUC_(24)/MIC(r=0.499,P<0.001),but it has a certain efficacy in predicting the achievement of the AUC_(24)/MIC standard(≥400)(area under the receiver operator characteristic curve=0.696),with an optimal cutoff value of 6.05 mg/L determined by the Youden index.The efficacy of AUC_(24)/MIC in predicting treatment failure was superior to c_(min)(areas under the receiver operator characteristic curve were 0.671 vs.0.523,P were 0.038 vs.0.684),with higher sensitivity(83.3%vs.66.7%).Hypoproteinemia and AUC_(24)/MIC≤369.1 were independent risk factors for vancomycin treatment failure(P<0.05).The incidence of nephrotoxicity was 3.4%.CONCLUSIONS There is a significant positive correlation between c_(min)and AUC_(24)/MIC of vancomycin in pediatric patients;hypoproteinemia and AUC_(24)/MIC≤369.1 are independent risk fa

关 键 词：万古霉素 稳态血药浓度谷值 24 h药时曲线下面积 最小抑菌浓度 相关性 危险因素 

分 类 号：R969[医药卫生—药理学]