CAJ | 학술논문

目的了解多黏菌素肾毒性的研究情况与临床特征,为临床安全使用多黏菌素提供参考. 方法以“polymyxin”、“colistin”、“colistimethate”、“nephrotoxicity”、“renal toxicity”和“多黏菌素”、“黏菌素”、“肾毒性”为检索词,检索PubMed、Embase、Web of Science、中国生物医学期刊引文数据库和中国生物医学文献数据库关于多黏菌素肾毒性的文献.用Excel表对最终纳入的文献建立评价数据库,记录文献语种、文献类型、发表年代、发文量排序前5位的国家和研究机构、载文量前5位的期刊、被引频次前10位的文献,分析有关文献的研究内容和热点,总结多黏菌素肾毒性的临床表现、发生机制及防治措施. 结果共纳入文献95篇,其中英文91篇,中文2篇,法文和葡萄牙文各1篇.论著82篇,综述13篇.首次发表多黏菌素肾毒性文献的时间是1952年.发表论文数量居前5位的国家分别是美国(29篇)、希腊(12篇)、土耳其(8篇)、澳大利亚(6篇)、韩国(5篇).文献的最高被引频次为156次.多黏菌素的给药方式为静脉滴注和雾化给药.肾损伤多出现在用药后4～10d.主要临床表现为肌痛、无力、尿液颜色变深、血尿、蛋白尿等.实验室检查显示血清肌酐含量升高和肌酐清除率降低.出现肾损伤后立即停药,并采取对症治疗,部分患者的肾功能可恢复到用药前状态.多黏菌素肾毒性的发生率随给药剂量增加而升高,随延长给药间隔而降低.多黏菌素肾毒性的机制尚不清楚,可能与增加细胞膜通透性及改变输尿管上皮细胞跨膜电位有关. 结论希腊对多黏菌素肾毒性的研究处于领先地位.高质量的论著更受研究者关注.减少用药剂量、延长用药间隔、联用具有保护肾功能作用的药物能减轻多黏菌素肾毒性程度.一旦发生多黏菌素所致肾损伤,应立即停药并对症治疗.
목적 료해다점균소신독성적연구정황여림상특정,위림상안전사용다점균소제공삼고. 방법 이“polymyxin”、“colistin”、“colistimethate”、“nephrotoxicity”、“renal toxicity”화“다점균소”、“점균소”、“신독성”위검색사,검색PubMed、Embase、Web of Science、중국생물의학기간인문수거고화중국생물의학문헌수거고관우다점균소신독성적문헌.용Excel표대최종납입적문헌건립평개수거고,기록문헌어충、문헌류형、발표년대、발문량배서전5위적국가화연구궤구、재문량전5위적기간、피인빈차전10위적문헌,분석유관문헌적연구내용화열점,총결다점균소신독성적림상표현、발생궤제급방치조시. 결과 공납입문헌95편,기중영문91편,중문2편,법문화포도아문각1편.론저82편,종술13편.수차발표다점균소신독성문헌적시간시1952년.발표논문수량거전5위적국가분별시미국(29편)、희석(12편)、토이기(8편)、오대리아(6편)、한국(5편).문헌적최고피인빈차위156차.다점균소적급약방식위정맥적주화무화급약.신손상다출현재용약후4～10d.주요림상표현위기통、무력、뇨액안색변심、혈뇨、단백뇨등.실험실검사현시혈청기항함량승고화기항청제솔강저.출현신손상후립즉정약,병채취대증치료,부분환자적신공능가회복도용약전상태.다점균소신독성적발생솔수급약제량증가이승고,수연장급약간격이강저.다점균소신독성적궤제상불청초,가능여증가세포막통투성급개변수뇨관상피세포과막전위유관. 결론 희석대다점균소신독성적연구처우령선지위.고질량적론저경수연구자관주.감소용약제량、연장용약간격、련용구유보호신공능작용적약물능감경다점균소신독성정도.일단발생다점균소소치신손상,응립즉정약병대증치료.
Objective To investigate the research progress in nephrotoxicity due to polymyxin and provide a reference for clinical safe use of polymyxin.Methods " Polymyxin "," colistin ","colistimethate"," nephrotoxicity",and " renal toxicity" were selected as the keywords and PubMed,Embase,Web of Science,Chinese Medical Citation Index,and Chinese BioMedical Disc were searched.All literature about nephrotoxicity due to polymyxin were enrolled.The evaluated databases of literature accepted for bibliometric study were establish by Microsoft Excel.The parameters of bibliometrics such as literature's language,literature's type,publication date,the countries and institutes ranking in the top 5 in publishing,top 5 journals in publishing number,and top 10 most frequently cited articles.The main content and hotspot of literature were analyzed.The clinical manifestations,mechanism,and prophylactico-therapeutic measures of nephrotoxicity due to polymyxin were summarized.Results A total of 95 articles (90 in English,3 in Chinese,1 in French and 1 in Portuguese) were enrolled in the study,of which 82 were original articles and 13 were reviews.The published time of first original publication of nephrotoxicity due to polymyxin was in 1952.The countries ranking in the top 5 in publishing were United States (29 pieces),Greece (12 pieces),Turkey (8 pieces),Australia (6 pieces),and Korea (5 pieces),respectively.The highest citation rate of article was 156 times.The mode of administration of polymyxin were intravenous infusion and nebulized inhalation.Kidney injury due to polymyxin usually occurred in 4-10 days after administration.The main clinical manifestations were myodynia,weakness,dark urine,hematuria,and proteinuria.Laboratory examination showed elevated serum creatinine and depressed creatinine clearance rate.After the drug withdrawal and supportive treatments,some patients' renal functions returned to the levels before administration.The incidence of nephrotoxicity due to polymyxin elevated following the increase of dosage and decreased following the lengthening of dosing interval.The mechanism of nephrotoxicity due to polymyxin was unknown,it may be related to the increase of membrane permeability and the change of transmembrane potential of ureteric epithelial cells.Conclusions Greece is ranked at the leading position in the research of nephrotoxicity due to polymyxin.The researchers pay more attention to the high-qulity articles.The degree of nephrotoxicity due to polymyxin can be alleviated by decreasing dose,extending the dosing interval,and combined use of kidney-protective drugs.Once kidney injury due to polymyxin occurred,the drug withdrawal and supportive treatments should be given immediately.