| 摘要: |
| 目的:分析儿童重症感染患者使用多黏菌素B 引发急性肾功能损伤(AKI)的临床特征和危险因素。方法:收集衡水市妇
幼保健院和首都医科大学附属北京儿童医院保定医院2021 年1 月至2024 年2 月接受多黏菌素B 治疗的儿童重症感染患者病
例资料,分为AKI 组和非AKI 组。分析AKI 发生率、发生时间、严重程度、转归及预后等,应用单因素及多因素logistic 回归分析
AKI 的危险因素,计算比值比(OR)及其95%置信区间(CI)。结果:共纳入157 例患儿,45 例(28. 66%) 发生多黏菌素B 相关
AKI,发生时间(6. 53±1. 36)天,全球肾脏疾病预后组织(KDIGO)分期Ⅰ、Ⅱ和Ⅲ期分别为26 例(57. 78%)、11 例(24. 44%)和8
例(17. 78%);41 例(91. 11%)停药后肾功能逐渐恢复,4 例(8. 89%)需要肾脏替代治疗。单因素分析结果显示,AKI 组和非AKI
组患儿在基线白蛋白、基线血乳酸、合并休克、联用清热解毒类中药注射剂、多黏菌素B 使用负荷剂量和日剂量比较,差异均有
统计学意义(P<0. 05);多因素logistic 回归分析结果显示,基线血乳酸>2. 0 mmol/ L(OR=1. 182,95%CI 1. 146~2. 865)、合并休
克(OR=3. 652,95%CI 1. 283~10. 395)和多黏菌素B 日剂量≥75 mg(OR=3. 015,95%CI 1. 169~7. 768)是多黏菌素B 致儿童重
症感染患者发生AKI 的独立危险因素(P<0. 05)。结论:儿童重症感染患者的多黏菌素B 相关AKI 发生率为28. 66%,高乳酸血
症、休克和多黏菌素B 负荷剂量用药是发生AKI 的独立危险因素。 |
| 关键词: 多黏菌素B 儿童重症感染 急性肾损伤 危险因素 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2025.01.009 |
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| 基金项目: |
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| Clinical Characteristics and Risk Factors of Acute Kidney Injury Induced by Polymyxin B in Children withSevere Infections |
| Han Luyan1, Bai Yamin1, Liu Jing1, Han Ying2, Zhang Simeng2, Liu Wenxin1 |
| ((1. Hengshui Maternal and Child Health
Hospital, Hebei Hengshui 053000, China; 2. Baoding Hospital, Beijing Children’ s Hospital, Capital Medical University, Hebei
Baoding 071000, China)) |
| Abstract: |
| Objective: To analyze the clinical characteristics and risk factors of acute kidney injury (AKI) induced by polymyxin B in
children with severe infections. Methods: Data of children with severe infection who received polymyxin B therapy in Hengshui Maternal
and Child Health Hospital and Baoding Hospital, Beijing Children’s Hospital, Capital Medical University from Jan. 2021 to Feb. 2024
were collected, all children were divided into the AKI group and non-AKI group. The incidence, occurrence time, severity, outcome and prognosis of AKI were analyzed. Risk factors for AKI were analyzed by univariate and multivariate logistic regression, odds ratios
(OR) and the 95% confidence intervals (CI) were calculated. Results: Totally 157 children were enrolled, and 45 cases (28. 66%)
developed polymyxin B-associated AKI, with a mean onset time of (6. 53± 1. 36) d. Kidney Disease: Improving Global Outcomes
(KDIGO) stage of Ⅰ, Ⅱ and Ⅲ were respectively 26 cases (57. 78%) ,11 cases (24. 44%) and 8 cases (17. 78%). The kidney
function of 41 cases (91. 11%) recovered after drug withdrawal, and 4 cases (8. 89%) needed kidney replacement therapy. Univariate
analysis showed that there were statistically significant differences between AKI group and non-AKI group in baseline albumin, baseline
blood lactic acid, complicated with shock, combined with heat clearing and detoxifying traditional Chinese medicine injection, and
loading doe and daily doe of polymyxin B (P<0. 05). Multivariate logistic regression analysis showed that baseline lactic acid >2. 0
mmol/ L (OR=1. 182, 95%CI 1. 146 to 2. 865), complicated with shock (OR= 3. 652, 95%CI 1. 283 to 10. 395) and daily dose of
polymyxin B ⩾75 mg (OR=3. 015, 95%CI 1. 169 to 7. 768) were independent risk factors for AKI induced by polymyxin B in children
with severe infections (P <0. 05). Conclusion: The incidence of AKI induced by polymyxin B in children with severe infections is
28. 66%. Hyperlactemia, shock and loading dose of polymyxin B are independent risk factors for AKI. |
| Key words: polymyxin B children with severe infections acute kidney injury risk factors |
