| 摘要: |
| 目的:回顾性分析昆明医科大学第一附属医院应用万古霉素的患儿血药浓度结果,统计万古霉素血药谷浓度(Cmin )、24 小时药
时曲线下面积(AUC24h) / 最低抑菌浓度(MIC)与临床疗效和肾功能的相关性,为儿童患者基于血药浓度结果调整万古霉素剂量提供参
考。方法:回顾性收集2019 年7 月至2023 年8 月符合纳入标准和排除标准的患儿相关信息,采用组间比较及组内前后对照的
分析方法考察不同万古霉素AUC24h / MIC、Cmin 区间与临床疗效及肾功能的相关性。绘制受试者工作特征(ROC) 曲线评估
AUC24h / MIC、Cmin 对临床疗效及肾损伤的预测效能。结果:共144 例患儿纳入研究,AUC24h / MIC≤400 mg·h/ L、400 mg·h/ L<
AUC24h / MIC≤600 mg·h/ L 及AUC24h / MIC>600 mg·h/ L 的3 组患儿间万古霉素AUC24h / MIC 与临床有效率及微生物清除率比
较差异均无统计学意义(P>0. 05);Cmin≤10 μg/ mL、10 μg/ mL20 μg/ mL 3 组患儿临床有效率及微生
物清除率比较差异均无统计学意义(P>0. 05);3 组患儿使用万古霉前后Δ 血肌酐、Δ 尿素氮及Δ 尿素氮/ 血肌酐比较差异均无
统计学意义(P>0. 05)。通过ROC 曲线分析,AUC24h / MIC 的有效暴露阈值为310.40 mg·h/ L,肾损伤的暴露阈值为528.11 mg·h/ L,
Cmin 的有效暴露阈值为5.63 μg/ mL,肾损伤的暴露阈值为11.51 μg/ mL。结论:儿童患者万古霉素AUC24h / MIC、Cmin 的有效性及肾损
伤阈值与成人比较存在差异,为保证临床疗效及安全性,有必要使儿童患者310. 40 mg·h/ L≤AUC24h / MIC≤528. 11 mg·h/ L 或
5. 63 μg/ mL≤Cmin≤11. 51 μg/ mL。但本研究样本量偏小,后续仍需大样本量研究加以验证。 |
| 关键词: 万古霉素 儿童 24 小时药时曲线下面积/ 最低抑菌浓度 疗效 肾功能 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2025.10.003 |
|
| 基金项目:云南省高层次卫生健康技术人才培养资助项目,编号D-2024010 |
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| Correlation Between Trough Concentration, 24-Hour Area Under the Concentration-Time Curve /Minimum Inhibitory Concentration of Vancomycin, Efficacy and Renal Function in Children |
| Li Juan, He Jin, Wu Hui, Wang Xi |
| ((The First Affiliated Hospital of Kunming Medical University, Kunming 650032, China)) |
| Abstract: |
| Objective: To retrospectively analyze the blood concentration of vancomycin in children admitted into the First Affiliated
Hospital of Kunming Medical University, and compare the correlation between vancomycin trough concentration (Cmin ), 24-hour area
under the concentration-time curve (AUC24h ) / minimum inhibitory concentration (MIC), clinical efficacy and renal function, so as to
provide reference for adjusting the dose of vancomycin based on blood concentration results in children. Methods: Relevant information
of children who met the inclusion and exclusion criteria from Jul. 2019 to Aug. 2023 were retrospectively collected. Correlation between
different AUC24h / MIC and Cmin of vancomycin, clinical efficacy and renal function were analyzed by using the inter-group comparative
and intra-group control method. Results: A total of 144 children were enrolled. There was no statistically significant difference in the
comparison of vancomycin AUC24h / MIC, clinical effective rate and microbial clearance rate among three groups with AUC24h / MIC≤
400 mg·h/ L, 400 mg·h/ L 600 mg·h/ L (P>0. 05). There was no statistically
significant difference in clinical effective rate and microbial clearance rate among three groups with Cmin≤ 10 μg/ mL, 10 μg/ mL 20 μg/ mL (P>0. 05). There was no statistically significant difference in the differences of serum creatinine, blood
urea nitrogen, and urea nitrogen/ serum creatinine values before and after treatment of vancomycin among three groups (P>0. 05). ROC
curve analysis indicated that the effective exposure threshold of AUC24h / MIC was 310. 40 mg·h/ L, the exposure threshold of renal
injury was 528. 11 mg·h/ L, the effective exposure threshold of Cmin was 5. 63 μg/ mL, and the exposure threshold of renal injury was
11. 51 μg/ mL. Conclusion: There are differences in the effectiveness of AUC24h / MIC and Cmin of vancomycin and the threshold of renal
injury between children and adults, in order to ensure clinical efficacy and safety, it is necessary to set 310. 40 mg·h/ L≤AUC24h / MIC≤
528. 11 mg·h/ L or 5. 63 μg/ mL≤Cmin≤11. 51 μg/ mL in children. However, the sample size of this study is relatively small, further
validation with larger sample size is still needed. |
| Key words: vancomycin children 24-hour area under the concentration-time curve/ minimum inhibitory concentration efficacy renal function |
