CAJ | 학술논문

目的：应用微量血清杀菌活性（SBA）测定对肾功能不全患者在抗菌药物临床治疗过程进行监测，对用药剂量和间隔时间进行合理调整，制定个体化给药方案，以提高药效和减少毒副作用。方法按肾功能减退时抗菌药物用药调整方案对使用头孢类抗菌药物治疗的48例肾功能不全[肾小球滤过率（GFR）＜50 mL／min]住院患者（中度肾功能不全患者36例，重度肾功能不全患者12例）进行治疗，应用自行设计的 SBA 方法测定患者峰时和谷时的 SBA 浓度。结果36例中度肾功能不全患者 SBA 测定结果峰值为1∶32～1∶128（中位数为1∶64），谷值为1∶8～1∶64（中位数为1∶32）；12例重度肾功能不全患者 SBA 测定结果峰值为1∶64～1∶512（中位数为1∶128），谷值为1∶16～1∶128（中位数为1∶64）。两组患者 SBA 均高于合理建议值（P ＜0．01）。结论肾功能不全患者在应用经肾脏代谢的抗菌药物时，存在用药过量而导致毒副作用的增加，加重肾功能的损害。肾功能不全的患者使用经肾脏代谢的抗菌药物治疗时，应同时进行 SBA 监测。
목적：응용미량혈청살균활성（SBA）측정대신공능불전환자재항균약물림상치료과정진행감측，대용약제량화간격시간진행합리조정，제정개체화급약방안，이제고약효화감소독부작용。방법안신공능감퇴시항균약물용약조정방안대사용두포류항균약물치료적48례신공능불전[신소구려과솔（GFR）＜50 mL／min]주원환자（중도신공능불전환자36례，중도신공능불전환자12례）진행치료，응용자행설계적 SBA 방법측정환자봉시화곡시적 SBA 농도。결과36례중도신공능불전환자 SBA 측정결과봉치위1∶32～1∶128（중위수위1∶64），곡치위1∶8～1∶64（중위수위1∶32）；12례중도신공능불전환자 SBA 측정결과봉치위1∶64～1∶512（중위수위1∶128），곡치위1∶16～1∶128（중위수위1∶64）。량조환자 SBA 균고우합리건의치（P ＜0．01）。결론신공능불전환자재응용경신장대사적항균약물시，존재용약과량이도치독부작용적증가，가중신공능적손해。신공능불전적환자사용경신장대사적항균약물치료시，응동시진행 SBA 감측。
Objective To monitor serum bactericidal activity(SBA)determination in renal insufficiency patients during antibiotics treatment,to adjust the antibiotics dosage and dosing interval,to formulate individualized dosing regimen,and to improve the treatment and decrease the side effects.Methods A total of 48 renal insufficiency [glomerular filtration rate (GFR)<50 mL/min]patients undergoing cephalosporin treatment were enrolled,including 36 cases with middle renal insufficiency and 1 2 cases with severe renal insufficiency,their antibiotics dosage and dosing interval were adjusted according to the guideline of antibiotics treatment for renal insufficiency patients,and the peak and valley SBA values were measured by the method we designed.Results In 36 patients with middle renal insufficiency,the peak SBA value was 1 ∶32-1 ∶1 28 (median 1 ∶64),and the valley SBA value was 1 ∶8-1 ∶64 (median 1 ∶32).In 1 2 patients with severe renal insufficiency,the peak SBA value was 1 ∶64-1 ∶51 2 (median 1 ∶1 28),and the valley SBA value was 1 ∶1 6-1 ∶1 28 (median 1 ∶64).The SBA values in the 2 groups were all higher than reasonable suggestion value(P <0.01 ).Conclusions In patients with renal insufficiency undergoing antibiotics treatment mainly metabolized by kidney,there will increase the side effects and renal insufficiency.It should monitor SBA value,when using antibiotics mainly metabolized by kidney in patients with renal insufficiency.