生物化工2024，Vol.10Issue(4) ：68-72.

以万古霉素为例探讨基于血清肌酐与胱抑素C计算的肾小球滤过率评估肾功能亢进的阈值

Taking Vancomycin as an Example Discuss the Evaluation the Augmented Renal Clearance Threshold Values Based on Glomerular Filtration Rate Calculated by Serum Creatinine and Cystatin C

陆雪芳 陆杰久 黄兴振
生物化工2024，Vol.10Issue(4) ：68-72.
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  • 维普
  • 万方数据

以万古霉素为例探讨基于血清肌酐与胱抑素C计算的肾小球滤过率评估肾功能亢进的阈值

Taking Vancomycin as an Example Discuss the Evaluation the Augmented Renal Clearance Threshold Values Based on Glomerular Filtration Rate Calculated by Serum Creatinine and Cystatin C

陆雪芳 1陆杰久 1黄兴振2
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作者信息

  • 1. 广西医科大学第一附属医院 药学部,广西南宁 530021
  • 2. 广西医科大学,广西南宁 530021
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摘要

目的:基于不同的肾小球滤过率计算公式,评估肾功能亢进(Augmented Renal Clearance,ARC)阈值对儿童患者万古霉素稳态谷浓度的影响.方法:回顾性收集2018年3月至2023年6月接受万古霉素静脉输注的2～18岁儿童患者.基于血清肌酐与胱抑素C两种标志物,采用不同的公式估算肾小球滤过率(eGFR),将eGFR大于 130 mL/(min·1.73 m2)的患者定义为ARC组,小于130 mL/(min·1.73 m2)的患者定义为非ARC组.两组间稳态谷浓度比较采用Mann-Whitney U检验.结果:共纳入220例儿童患者,349个稳态谷浓度点.患者的平均年龄为9.4岁.eGFRSchwartz、eGFRCG、eGFRMDRD、eGFRCKD-Scr的中位数分别为 194.3 mL/(min·1.73 m2)、117.9 mL/(min·1.73 m2)、340.3 mL/(min·1.73 m2)、180.8 mL/(min·1.73 m2).eGFRCKD-Scr-CysC、eGFRCKD-CysC、eGFRHoek的中位数分别为161.1 mL/(min·1.73 m2)、134.5 mL/(min·1.73 m2)、62.2 mL/(min·1.73 m2).在Schwartz公式、MDRD公式与CKD-EPI公式计算的eGFR中,ARC组与非ARC组间的万古霉素稳态谷浓度有统计学差异(p＜0.05),在Cockcroft-Gault公式、Hoek公式计算的eGFR中,ARC组与非ARC组间的万古霉素稳态谷浓度无统计学差异(p＞0.05).结论:以 130 mL/(min·1.73 m2)为阈值,在Schwartz公式、MDRD公式与CKD-EPI公式中肾功能亢进对万古霉素稳态谷浓度有显著影响,ARC的阈值在不同计算公式中的适用性仍需进一步研究.

Abstract

Objective:Based on different formulas for calculating glomerular filtration rate,the effect of augmented renal clearance(ARC)threshold on the steady trough concentration of vancomycin in children is evaluated.Methods:Data are retrospectively obtained from pediatric patients that identified 2 to 18 years who received vancomycin treatment for infection from March 2018 to June 2023.Based on serum creatinine and cystatin C,different formulas are used to estimate the glomerular filtration rate(e GFR),patients with e GFR greater than 130 mL/(min·1.73 m2)are defined as ARC group,and patients with less than 130 mL/(min·1.73 m2)are defined as non-ARC group.Mann-Whitney U test is used to compare the steady-state trough concentration between the two groups.Results:A total of 220 pediatric patients are included,with 349 steady-state trough concentrations.The average age of the patients is 9.4 years.The median value of eGFRSchwartz,eGFRCG,eGFRMDRD,eGFRCKD-Scr are 194.3 mL/(min·1.73 m2),117.9 mL/(min·1.73 m2),340.3 mL/(min·1.73 m2),180.8 mL/(min·1.73 m2),respectively.The median value of eGFRCKD-Scr-CysC,eGFRCKD-CysC,eGFRHoek are 161.1 mL/(min·1.73 m2),134.5 mL/(min·1.73 m2),62.2 mL/(min·1.73 m2),respectively.Vancomycin steady-state trough concentration between the ARC group and the non-ARC group is statistically different in Schwartz,MDRD and CKD-EPI formula(p<0.05).There is no statistically significant difference in vancomycin steady-state trough concentration between the ARC group and the non-ARC group in Cokcroft-Gault and Hoek formula(p>0.05).Conclusion:Using 130 mL/(min·1.73 m2)as the threshold,augmented renal clearance has a significant effect on the vancomycin steady-state trough concentration in the Schwartz,MDRD and CKD-EPI equation.The applicability of the ARC threshold to different formulas still needs further research.

关键词

肾小球滤过率/万古霉素/肾功能亢进/儿童患者/血药浓度

Key words

glomerular filtration rate/vancomycin/augmented renal clearance/pediatric patients/plasma drug concentration

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出版年

2024
生物化工

生物化工

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