儿科药学杂志2025，Vol.31Issue(1) ：44-47.DOI:10.13407/j.cnki.jpp.1672-108X.2025.01.009

多黏菌素B致儿童重症感染患者急性肾损伤的临床特征及危险因素分析

Clinical Characteristics and Risk Factors of Acute Kidney Injury Induced by Polymyxin B in Children with Severe Infections

韩露燕 白雅敏 刘静 韩英 张思梦 刘文新
儿科药学杂志2025，Vol.31Issue(1) ：44-47.DOI:10.13407/j.cnki.jpp.1672-108X.2025.01.009
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多黏菌素B致儿童重症感染患者急性肾损伤的临床特征及危险因素分析

Clinical Characteristics and Risk Factors of Acute Kidney Injury Induced by Polymyxin B in Children with Severe Infections

韩露燕 1白雅敏 1刘静 1韩英 2张思梦 2刘文新1
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作者信息

  • 1. 衡水市妇幼保健院,河北衡水 053000
  • 2. 首都医科大学附属北京儿童医院保定医院,河北保定 071000
  • 折叠

摘要

目的:分析儿童重症感染患者使用多黏菌素B引发急性肾功能损伤(AKI)的临床特征和危险因素.方法:收集衡水市妇幼保健院和首都医科大学附属北京儿童医院保定医院2021年1月至2024年2月接受多黏菌素B治疗的儿童重症感染患者病例资料,分为AKI组和非AKI组.分析AKI发生率、发生时间、严重程度、转归及预后等,应用单因素及多因素logistic回归分析AKI的危险因素,计算比值比(OR)及其95％置信区间(CI).结果:共纳入157例患儿,45例(28.66％)发生多黏菌素B相关AKI,发生时间(6.53±1.36)天,全球肾脏疾病预后组织(KDIGO)分期Ⅰ、Ⅱ和Ⅲ期分别为26例(57.78％)、11例(24.44％)和8例(17.78％);41例(91.11％)停药后肾功能逐渐恢复,4例(8.89％)需要肾脏替代治疗.单因素分析结果显示,AKI组和非AKI组患儿在基线白蛋白、基线血乳酸、合并休克、联用清热解毒类中药注射剂、多黏菌素B使用负荷剂量和日剂量比较,差异均有统计学意义(P＜0.05);多因素logistic回归分析结果显示,基线血乳酸＞2.0 mmol/L(OR=1.182,95％CI 1.146～2.865)、合并休克(OR=3.652,95％CI 1.283～10.395)和多黏菌素 B日剂量 ≥75 mg(OR=3.015,95％CI 1.169～7.768)是多黏菌素 B 致儿童重症感染患者发生AKI的独立危险因素(P＜0.05).结论:儿童重症感染患者的多黏菌素B相关AKI发生率为28.66％,高乳酸血症、休克和多黏菌素B负荷剂量用药是发生AKI的独立危险因素.

Abstract

Objective:To analyze the clinical characteristics and risk factors of acute kidney injury(AKI)induced by polymyxin B in children with severe infections.Methods:Data of children with severe infection who received polymyxin B therapy in Hengshui Maternal and Child Health Hospital and Baoding Hospital,Beijing Children's Hospital,Capital Medical University from Jan.2021 to Feb.2024 were collected,all children were divided into the AKI group and non-AKI group.The incidence,occurrence time,severity,outcome and prognosis of AKI were analyzed.Risk factors for AKI were analyzed by univariate and multivariate logistic regression,odds ratios(OR)and the 95％confidence intervals(CI)were calculated.Results:Totally 157 children were enrolled,and 45 cases(28.66％)developed polymyxin B-associated AKI,with a mean onset time of(6.53±1.36)d.Kidney Disease:Improving Global Outcomes(KDIGO)stage of Ⅰ,Ⅱ and Ⅲ were respectively 26 cases(57.78％),11 cases(24.44％)and 8 cases(17.78％).The kidney function of 41 cases(91.11％)recovered after drug withdrawal,and 4 cases(8.89％)needed kidney replacement therapy.Univariate analysis showed that there were statistically significant differences between AKI group and non-AKI group in baseline albumin,baseline blood lactic acid,complicated with shock,combined with heat clearing and detoxifying traditional Chinese medicine injection,and loading doe and daily doe of polymyxin B(P＜0.05).Multivariate logistic regression analysis showed that baseline lactic acid＞2.0 mmol/L(OR=1.182,95％CI 1.146 to 2.865),complicated with shock(OR=3.652,95％CI 1.283 to 10.395)and daily dose of polymyxin B ≥75 mg(OR=3.015,95％CI 1.169 to 7.768)were independent risk factors for AKI induced by polymyxin B in children with severe infections(P＜0.05).Conclusion:The incidence of AKI induced by polymyxin B in children with severe infections is 28.66％.Hyperlactemia,shock and loading dose of polymyxin B are independent risk factors for AKI.

关键词

多黏菌素B/儿童重症感染/急性肾损伤/危险因素

Key words

polymyxin B/children with severe infections/acute kidney injury/risk factors

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出版年

2025
儿科药学杂志
重庆医科大学附属儿童医院，中国药学会儿科药学专业组

儿科药学杂志

影响因子：1.03
ISSN：1672-108X
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