CAJ | 학술논문

目的：探讨重症感染患者发生万古霉素相关急性肾损伤（AKI）的临床特点以及相关因素分析。方法选择南京大学医学院附属鼓楼医院重症医学科2013年2月至2013年8月使用万古霉素经验性或目标性抗感染治疗的患者53例，监测万古霉素血药浓度（谷浓度）、血肌酐和肌酐清除率，并记录患者基础状态、万古霉素的用药剂量及疗程。依据用药期间是否发生AKI分为AKI组和非AKI组，将肾功能、万古霉素血药浓度、万古霉素用药剂量和疗程分别进行单因素分析和Logistic回归分析，筛选万古霉素相关肾损伤的危险因素。结果53例患者中有11例发生AKI，发生率为21.0%，AKI组病死率为27.3%。两组患者用药前基础血肌酐和尿素氮无统计学差异， AKI组患者用药前肌酐清除率（67.00±39.59ml/min）低于非AKI组（101.33±51.22ml/min），p=0.046，低血压的例数（6例）多于非AKI组（5例），p=0.003；两组患者首次万古霉素谷浓度无统计学差异，AKI组患者平均万古霉素谷浓度、最大谷浓度较非AKI组患者高（17.88±4.90mg/L比13.95±4.44mg/L，22.39±7.70mg/L比17.23±6.01mg/L，p=0.017和p=0.027）。Logistic回归分析显示，平均万古霉素谷浓度（OR=1.247，95%CI，1.028-1.514， p=0.025）与低血压（OR=10.759，95%CI，1.667-69.442,p=0.013）是引起万古霉素相关AKI发生的危险因素。结论万古霉素谷浓度和低血压是影响万古霉素相关急性肾损伤的独立危险因素，用药期间需定期检测血药浓度。
목적：탐토중증감염환자발생만고매소상관급성신손상（AKI）적림상특점이급상관인소분석。방법선택남경대학의학원부속고루의원중증의학과2013년2월지2013년8월사용만고매소경험성혹목표성항감염치료적환자53례，감측만고매소혈약농도（곡농도）、혈기항화기항청제솔，병기록환자기출상태、만고매소적용약제량급료정。의거용약기간시부발생AKI분위AKI조화비AKI조，장신공능、만고매소혈약농도、만고매소용약제량화료정분별진행단인소분석화Logistic회귀분석，사선만고매소상관신손상적위험인소。결과53례환자중유11례발생AKI，발생솔위21.0%，AKI조병사솔위27.3%。량조환자용약전기출혈기항화뇨소담무통계학차이， AKI조환자용약전기항청제솔（67.00±39.59ml/min）저우비AKI조（101.33±51.22ml/min），p=0.046，저혈압적례수（6례）다우비AKI조（5례），p=0.003；량조환자수차만고매소곡농도무통계학차이，AKI조환자평균만고매소곡농도、최대곡농도교비AKI조환자고（17.88±4.90mg/L비13.95±4.44mg/L，22.39±7.70mg/L비17.23±6.01mg/L，p=0.017화p=0.027）。Logistic회귀분석현시，평균만고매소곡농도（OR=1.247，95%CI，1.028-1.514， p=0.025）여저혈압（OR=10.759，95%CI，1.667-69.442,p=0.013）시인기만고매소상관AKI발생적위험인소。결론만고매소곡농도화저혈압시영향만고매소상관급성신손상적독립위험인소，용약기간수정기검측혈약농도。
objective The purpose of this study was to evaluate risk factors that may result patients with severe infection to acute kidney injury in receiving vancomycin treatment. Methods This was a single-center retrospective study of 53 patiens with severe infections who were receiving vancomycin from February 1st 2013 to August 1st 2013.Vancomycin trough concentrations and renal function were monitored during therapy.Date colected included the general conditions,vancomycin dose,length of vancomycin therapy.These were used to identify univariate for vancomycin associated acute kindey injury. The univariate analysis statisticaly significant factor Logistc regression analysis. Results Among 53 subjects,11(21.0%)develeped acute kidney injury,the mortality rate was 27.3%.The initial serum creatinine and Uremic nitrogen did not differ between the two groups.The patients in AKI group had lower initialy creatinine clearance(67.00±39.59ml/min vs 101.33±51.22ml/min,p=0.046),and the higher proportion of hypertension[6(54.5%) vs 5(11.9%),p=0.003]. The initial vancomycin through concentrations did not differ between the two groups .The average vancomycin trough concentrations and maximum trough concentration were higher among patients in AKI group than the patients in non-AKI group(17.88±4.90mg/L vs 13.95±4.44 mg/L,22.39±7.70 mg/L vs 17.23±6.01 mg/L,p=0.017 and p=0.027).Multivariate modeling identified that the average vancomycin trough concentrations[odd ratio(OR)1.247,95% confidence interval(95% CI 1.028-1.514),p=0.025]and hypotension[odd ratio(OR) 10.759,95% confidence interval(95% CI 1.667-69.442),p=0.013]were the independent predictors for vancomycin associated acute kidney injury. Conclusion The average vancomycin trough concentrations and hypertension were the independent predictors for induced acute kidney injury in patients with severe infection. Monitoring of drug concentration is necessary during the vancomycin therapy.