肾功能亢进对万古霉素血药谷浓度的影响  

The Impact of Hyperrenal Function on Serum Vancomycin Trough Concentrations

作　　者：方昊 付凯 王永辉 FANG Hao;FU Kai;WANG Yonghui(Department of Pharmacy,Central Hospital of Zhumadian,Zhumadian Henan 463000,China)

机构地区：[1]驻马店市中心医院药学部,河南驻马店463000

出　　处：《临床研究》2025年第5期48-51,共4页Clinical Research

基　　金：基于拉曼增强基底的万古霉素血药浓度检测系统构建与临床用药指导(222102310272)。

摘　　要：目的观察肾功能亢进(ARC)对万古霉素血药谷浓度的影响。方法选择2021年8月至2023年8月于驻马店市中心医院采用万古霉素治疗的70例肾功能亢进患者,将35例内生肌酐清除率(Ccr)≥130 mL/(min·1.73 m^(2)),即肾功能亢进的患者设为试验组,35例Ccr<130 mL/(min·1.73 m^(2)),即肾功能正常的患者设为对照组。对比两组万古霉素使用时间、万古霉素血药谷浓度(C_(min))、C_(min)分布区间占比及用药前后C反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)和中性粒细胞计数(NEUT)。结果试验组万古霉素使用时间少于对照组,但差异无统计学意义(P>0.05)。试验组C_(min)低于对照组,差异有统计学意义(P<0.05)。两组<10 mg·L^(-1)和>20 mg·L^(-1)的谷浓度占比分别比较,差异均有统计学意义(P<0.05)。用药后,试验组CRP和PCT水平高于对照组,差异有统计学意义(P<0.05);WBC和NEUT水平与对照组比较,差异无统计学意义(P>0.05)。结论肾功能亢进可降低C_(min),影响感染控制,降低治疗效果。建议临床尽早筛查、确诊,调整万古霉素给药方案,从而提高疗效,减少不良反应。Objective To observe the effect of hyperrenal function on serum vancomycin trough concentrations.Methods Seventy patients with hyperrenal function treated with vancomycin at Zhumadian Central Hospital from August 2021 to August 2023 were selected.Among them,35 patients with endogenous creatinine clearance rate(Ccr)≥130 mL/(min·1.73 m²),indicating hyperrenal function,served as the experimental group.The other 35 patients with Ccr<130 mL/(min·1.73 m²),indicating normal renal function,served as the control group.The two groups were compared in terms of vancomycin usage duration,serum vancomycin trough concentrations,the proportion of concentration distribution ranges,and inflammatory biomarkers-including C-reactive protein(CRP),white blood cell count(WBC),procalcitonin(PCT),and neutrophil count(NEUT)-before and after medication.Results The experimental group had a shorter duration of vancomycin use than the control group,but this difference was not statistically significant(P>0.05).The serum vancomycin trough concentration in the experimental group was lower than that in the control group,with a statistically significant difference(P<0.05).The proportions of concentrations<10 mg/L and>20 mg/L in both groups showed statistically significant differences(P<0.05).After medication,levels of CRP and PCT in the experimental group were higher than those in the control group,with significant differences(P<0.05).The levels of WBC and NEUT showed no statistically significant difference compared to the control group(P>0.05).Conclusion Hyperrenal function can reduce serum vancomycin trough concentration,thereby impairing infection control and decreasing therapeutic efficacy.It is recommended that clinicians conduct early screening and diagnosis of renal function,adjust vancomycin dosing regimens accordingly,to improve treatment outcomes and reduce adverse reactions.

关 键 词：万古霉素 肾功能亢进 血药浓度 药物监测 

分 类 号：R322.61[医药卫生—人体解剖和组织胚胎学]