肾功能正常患者万古霉素稳态谷浓度分布及影响因素分析

目的 考察肾功能正常患者万古霉素稳态谷浓度的分布情况，明确影响万古霉素稳态谷浓度的相关因素。方法 收集肾功能正常(肌酐清除率≥50mL/min)且接受万古霉素常规给药方案(1g q12h)治疗的感染患者血样，采用酶免疫扩大法测定万古霉素稳态谷浓度，应用有序多元Logistic回归分析万古霉素稳态谷浓度与患者基本资料及生化指标的相关性。结果 纳入331例符合入排标准的感染患者，统计分析发现，41%(136/331)的患者万古霉素稳态谷浓度低于10μg/mL，而稳态谷浓度高于20μg/mL占15%(48/331)，仅44%(147/331)的稳态谷浓度达到指南推荐的目标范围(10~20μg/mL)。有序多元Logistic回归结果显示，患者的年龄(P<0.001)、体重(P<0.001)、肌酐清除率(P<0.001)、重症感染(P=0.022)以及高血压(P=0.022)是影响万古霉素稳态谷浓度的危险因素。结论 可以根据患者的年龄、体重、肌酐清除率、感染类型及血压情况来综合调整万古霉素的给药方案，以更好地实现个体化用药。

Analysis of influencing factors and distribution on vancomycin trough concentration in patients with normal renal functions

Objective To investigate the distribution on vancomycin trough concentration in patients with normal renal function, and clarify the related factors effecting the vancomycin trough concentration. Methods Blood samples were collected from the patients with normal renal functions (creatine clearance rate≥50mL/min) who received vancomycin administration (1g q12h). The vancomycin trough concentration was measured by enzyme multiplied immunoassay technique (EMIT). A multiple logistic regression analysis was used to explore the relationship between the vancomycin trough concentration and influencing factors. Results There were 331 patients receiving vancomycin were included and 41% (136/331) patients whose vancomycin trough concentration were under 10μg/mL, and 15% (48/331) above 20μg/mL. However, only 44% (147/331) reached the target range (10~20μg/mL) recommended by the guide. The result of multiple linear regression showed that the vancomycin trough concentration related with the age, weight, creatine clearance rate, severe infection and hypertension. Conclusion The vancomycin treatment regimen could be altered by the patients' age, weight, creatine clearance rate, infection type, and blood pressure in order to deliver a better individual