| 摘要: |
| 目的:基于药物浓度监测探讨万古霉素相关儿童急性肾损伤(VA-AKI)的危险因素,为临床安全用药提供参考。 方法: 回顾性分析南通大学附属常州儿童医院 2021 年 11 月至 2024 年 10 月使用万古霉素并监测血药浓度的患儿病例资料,对血药浓 度、人口统计学、临床资料及相关实验室检查等数据进行分析。 结果:共纳入 120 例患儿,其中男 68 例,女 52 例,年龄 12 d ~ 13 岁 6 个月;万古霉素用药疗程 3 ~ 28 d。 VA-AKI 发生率为 14. 17% ( 17 / 120),AKI 组与非 AKI 组通过单因素分析和多因素 logistic 回归分析显示,万古霉素谷浓度高和入住重症监护室(ICU)为 VA-AKI 的独立危险因素。 不同谷浓度组 AKI 发生率比较 结果显示,谷浓度> 15 μg / mL 时 AKI 发生率最高,为 60. 00%;而谷浓度< 5 μg / mL 组和 5 ~ 15 μg / mL 组 AKI 发生率分别为 2. 94%和 13. 16%,且各谷浓度组间 AKI 发生率比较差异有统计学意义(P<0. 05)。 结论:万古霉素谷浓度高和入住 ICU 为儿童 VA-AKI 的独立危险因素,谷浓度>15 μg / mL 时,VA-AKI 发生率明显升高。 |
| 关键词: 儿童 万古霉素 药物浓度监测 危险因素 急性肾损伤 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2025.09.001 |
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| 基金项目:常州市科技基础设施建设计划-常州市临床药学重点实验室项目,编号 CM20223005;常州市科技局应用基础研究指导性课题,编 号 CJ20239036 |
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| Risk Factors for Vancomycin-Associated Acute Kidney Injury in Children Based on Drug Concentration Monitoring |
| Hu Meihui1,2 , Zheng Aibin1 , Li Huanzhou1 , Li Jinquan1 , Liu Fei1 , Zhang Wenting1 |
| (1. Affiliated Changzhou Children’ s Hospital of Nantong University, Jiangsu Changzhou 213018, China; 2. Changzhou Key Laboratory of Clinical Pharmacy, Jiangsu Changzhou 213000, China) |
| Abstract: |
| Objective: To explore the risk factors for vancomycin-associated acute kidney injury (VA-AKI) in children based on drug concentration monitoring, so as to provide reference for safe clinical medication. Methods: Retrospective analysis was performed on clinical data of children received vancomycin and monitored for blood concentration in the Affiliated Changzhou Children’ s Hospital of Nantong University from Nov. 2021 to Oct. 2024. Data of blood concentration, demography, clinical information and related laboratory tests were analyzed. Results: A total of 120 children were enrolled, including 68 males and 52 females, aged from 12 d to 13 years and 6 months. Vancomycin was administered for 3 to 28 d. The incidence of VA-AKI was 14. 17% ( 17 / 120). Univariate analysis and multivariate logistic regression analysis showed that high trough concentration of vancomycin and admission of intensive care unit (ICU) were independent analysis factors for VA-AKI. Comparison of AKI incidence across different trough concentration groups showed that the highest incidence of AKI (60. 00%) occurred when trough concentration >15 μg / mL, which was significantly higher than the overall incidence; whereas the incidence of AKI in the groups with trough concentrations <5 μg / mL and 5 to 15 μg / mL was respectively 2. 94% and 13. 16%, both lower than the overall incidence. The differences in incidence of AKI among the trough concentration groups were statistically significant (P<0. 05). Conclusion: High trough concentration of vancomycin and admission of ICU are the independent risk factors for VA-AKI in children, and the incidence of VA-AKI significantly increases when the trough concentration >15 μg / mL. |
| Key words: children vancomycin drug concentration monitoring risk factor acute kidney injury |
