| 摘要: |
| [摘要]目的：探讨低蛋白血症患儿白蛋白水平对万古霉素血药浓度的影响，为临床低蛋白血症患儿个体化治疗提供参考。方法：收集2016年5月至2019年5月于四川省自贡市第一人民医院就诊并行万古霉素血药浓度监测的65例患儿临床资料，根据不同白蛋白水平分为低蛋白血症组30例（白蛋白浓度<30 g/L）与正常对照组35例（白蛋白浓度≥30 g/L），观察两组患儿血浆白蛋白水平、万古霉素谷浓度，记录患儿在不同年龄段对万古霉素血药浓度监测结果的影响及患儿第5次用药后血药浓度在治疗窗内所占比例。采用多元线性回归分析患儿白蛋白水平与万古霉素血药浓度的相关性，观察不良反应发生情况。采用单因素分析与多因素Logistic回归分析万古霉素血药浓度不达标的相关因素。结果：低蛋白血症组患儿平均白蛋白水平、万古霉素谷浓度均低于正常对照组（P<0.05）；两组患儿≤28 d、29 d~1岁、>1~3岁、>3~6岁、>6~12岁万古霉素谷浓度组间比较差异有统计学意义（P<0.05），低蛋白血症组>3~6岁、>6~12岁万古霉素谷浓度低于正常对照组（P<0.05），其中低蛋白血症组万古霉素谷浓度在治疗窗内为26.67%（8/30），正常对照组为42.86%（15/35），差异无统计学意义（P>0.05）。Spearman相关分析结果显示，患儿白蛋白水平与万古霉素血药浓度呈正相关（P<0.05）；7例患儿出现肝酶升高、3例皮疹、2例白细胞减少。多因素Logistic回归分析结果显示，药物用法用量不合理、合并基础疾病是导致万古霉素血药浓度不达标的独立危险因素（P<0.05）。结论：低蛋白血症患儿受多因素影响，万古霉素血药浓度个体差异较大，临床应积极监测低蛋白血症患儿血药浓度，以调整用药。 |
| 关键词: 低蛋白血症 万古霉素 血药浓度 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2021.10.006 |
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| 基金项目: |
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| Effects of Albumin Levels on Blood Concentration of Vancomycin in Children with Hypoalbuminemia |
| Long Yuyu, Zhang Xiaojun, Li Hongyu |
| (Sichuan Zigong First People’s Hospital, Sichuan Zigong 643000, China) |
| Abstract: |
| [Abstract] Objective: To explore the effects of albumin levels on blood concentration of vancomycin in children with hypoalbuminemia, so as to provide reference for individualized therapy in children with hypoproteinemia. Methods: Clinical data of 65 children with blood concentration monitoring of vancomycin in Sichuan Zigong First People’s Hospital from May 2016 to May 2019 were collected. According to different albumin levels, all patients were divided into the hypoalbuminemia group (30 cases with albumin levels <30 g/L) and the normal control group (35 cases with albumin levels ≥30 g/L). The albumin levels and valley concentration of vancomycin in two groups were observed, and the effects of different ages on the monitoring results of blood concentration of vancomycin and proportion of the fifth drug concentration in the treatment window were recorded. Multiple linear regression was used to analyze the correlation between albumin levels and blood concentration of vancomycin in children, and the occurrence of adverse drug reactions were observed. Univariate analysis and multivariate Logistic regression were used to analyze the factors associated with non-attainment of blood drug concentration. Results: The mean albumin levels and valley concentration of vancomycin in the hypoproteinemia group were lower than those in the normal control group (P<0.05). The difference in valley concentration of vancomycin between two groups of children ≤28 d, from 29 d to 1 year old, >1 to 3 years old, >3 to 6 years old, and >6 to 12 years old was statistically significant (P<0.05). The valley concentration of vancomycin in the hypoalbuminemia group of children >3 to 6 years old, >6 to 12 years old was lower than that in the normal control group (P<0.05). The proportion of valley concentration of vancomycin within the treatment window was 26.67% (8/30) in the hypoalbuminemia group and 42.86% (15/35) in the normal control group, the difference was not statistically significant (P>0.05). Spearman correlation analysis showed the positive correlation between albumin levels and blood concentration of vancomycin in children (P<0.05). There were 7 cases of children had elevated liver enzymes, 3 cases of skin rash, and 2 cases of leukopenia. Multivariate logistic regression analysis showed that irrational drug usage and dosage, complicated with underlying diseases were independent risk factors for non-attainment of blood drug concentration of vancomycin (P<0.05). Conclusion: Children with hypoproteinemia are affected by multiple factors, and the blood concentration of vancomycin varies greatly among individuals. Clinical monitoring of blood concentration in children with hypoproteinemia should be actively performed to adjust the administration. |
| Key words: hypoproteinemia vancomycin blood concentration |
