两性霉素 B脂质体治疗侵袭性真菌感染病人发生急性肾损伤危险因素分析

目的研究两性霉素 B脂质体(L-AMB)治疗侵袭性真菌感染病人发生急性肾损伤(AKI)的危险因素。方法回顾性分析南京医科大学附属淮安第一医院 2018年 1月至 2021年 12月 61例两性霉素 B脂质体治疗侵袭性真菌感染病人的临床资料，根据是否发生两性霉素 B脂质体相关 AKI分为 AKI组 23例( 37.7%)非 AKI组 38例( 62.3%)。采用单因素分析法比较两组临床资料， logistic回归分析两性霉素 B脂质体( L-AMB)治疗侵袭性真菌感，染病人发生 AKI的危险因素，应用受试者操作特征曲线( ROC曲线)评价 L-AMB使用累积剂量及治疗前血清钾水平在诊断 AKI方面的能力。结果有 23例病人在使用 L-AMB治疗过程中发生 AKI，AKI发生率为 37.7%。L-AMB疗程、累积剂量、日剂量， L-AMB治疗前血钾水平在 AKI及非 AKI两组病人比较中均差异有统计学意义(均 P<0.05)；累积剂量是发生 L-AMB相关 AKI的独立危险因素［ OR=1.46，95%CI:(1.08，1.98)，P=

Analysis of risk factors for acute kidney injury in patients with invasive fungal infection treated with liposomal amphotericin B

Objective To investigate the risk factors for acute kidney injury (AKI) in patients with invasive fungal infection treatedwith liposomal amphotericin B (L-AMB).Methods The clinical data of 61 patients with invasive fungal infection treated with amphotericin B liposome from January 2018 to December 2021 in the Affiliated Huaian NO.1 People''s Hospital of NanJing Medical University were analyzed retrospectively. According to the incidence of acute renal injury associated with liposomal amphotericin B, 23 patients(37.7%) were in AKI group and 38 patients (62.3%) were in non-AKI group. The clinical data of the two groups were compared by single factor analysis, the logistic regression was used to analyze the risk factors of acute renal injury in patients with invasive fungal infection treated with L-AMB, and receiver operating characteristic curve was used to evaluate the cumulative dose of L-AMB and the ability of serum potassium levels in the diagnosis of AKI before treatment.Results Twenty-three patients developed AKI during treatment with L-AMB, and the incidence rate was 37.7%. Before the treatment of L-AMB, there were significant differences in the treatmentcourse, cumulative dose, daily dose and serum potassium levels between AKI patients and non-AKI patients (all P<0.05). Cumulative dose was an independent risk factor for L-AMB-related AKI OR=1.46, 95% CI: (1.08, 1.98), P=0.014]; Hypokalemia before L-AMB treatment was another independent risk factor for acute renal injury associated with L-AMB OR=0.05,95% CI:(0.01, 0.43), P=0.007].The area under the curve (AUC) of the cumulative dose and serum potassium level before treatment were 0.88 (0.79, 0.98) and 0.88(0.79, 0.96), respectively. The sensitivity was 86.9% and 81.5%, and the specificity was 89.4% and 86.9%, respectively.Conclusions The cumulative dose of L-AMB and the level of hypokalemia before treatment are independent risk factors for L-AMB-related AKI. Both have certain predictive value in the diagnosis of L-AMB-related acute renal injury, and the diagnostic value of cumulative doses is greater than that of pretreatment hypokalemia levels.