重症患者发生万古霉素相关急性肾损伤的危险因素分析
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摘要
目的探讨重症患者发生万古霉素相关急性肾损伤(VI-AKI)的危险因素。方法 58例重症患者根据是否发生VI-AKI分为AKI者13例(AKI组)和没有发生AKI者45例(非AKI组),采用单因素分析法比较两组临床资料,多因素Logistic回归分析法分析重症患者发生VI-AKI的危险因素。结果与非AKI组比较,AKI组高尿酸血症及联合应用利尿剂、血管活性药物比率高,血清白蛋白水平低(P均<0.05);多因素Logistic回归分析显示,高尿酸血症及联合应用利尿剂是发生AKI的独立危险因素,血清白蛋白水平是AKI的独立保护因素。结论高尿酸血症及联合应用利尿剂是重症患者发生VI-AKI的独立危险因素,血清白蛋白水平其独立保护因素。
Objective To investigate the risk factors of vancomycin-induced acute kidney injury(VI-AKI) in intensive care unit(ICU) patients.Methods Fifty-eight patients were enrolled and then were divided into the AKI group(13 patients with AKI) and NO-AKI group(45 patients without AKI).The clinical data of the two groups were compared by univariate analysis.Multiple logistic regression analysis was used to analyze the risk factors of VI-AKI in ICU patients.Results Compared with the NO-AKI group,AKI group had hyperuricemia,a higher ratio of using diuretic and vasoactive drugs,and lower serum albumin level(all P<0.05).Multiple logistic regression analysis showed that hyperuricemia and diuretics were independent risk factors for VI-AKI,and serum albumin was known as an independent protective factor for VI-AKI.Conclusion Hyperuricemia and the combined diuretics are independent risk factors for VI-AKI in severe patients,and serum albumin is an independent protective factor.
Objective To investigate the risk factors of vancomycin-induced acute kidney injury(VI-AKI) in intensive care unit(ICU) patients.Methods Fifty-eight patients were enrolled and then were divided into the AKI group(13 patients with AKI) and NO-AKI group(45 patients without AKI).The clinical data of the two groups were compared by univariate analysis.Multiple logistic regression analysis was used to analyze the risk factors of VI-AKI in ICU patients.Results Compared with the NO-AKI group,AKI group had hyperuricemia,a higher ratio of using diuretic and vasoactive drugs,and lower serum albumin level(all P<0.05).Multiple logistic regression analysis showed that hyperuricemia and diuretics were independent risk factors for VI-AKI,and serum albumin was known as an independent protective factor for VI-AKI.Conclusion Hyperuricemia and the combined diuretics are independent risk factors for VI-AKI in severe patients,and serum albumin is an independent protective factor.
引文
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[7]罗洁,徐芬,丁岚.万古霉素对大鼠肾小管上皮细胞肾损伤定量评价及其机制研究[J].江西医药,2018,53(1):26-28.
[8]Jin J,Li M,Zhao Z,et al.Protective effect of Wuzhi tablet(Schisandra sphenanthera extract)against cisplatin-induced nephrotoxicity via Nrf2-mediated defense response[J].Phymed,2015,22(5):528-535.
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[11]Pan KM,Wu Y,Chen C,et al.Vancomycin-induced acute kidney injury in elderly Chinese patients:a single-centre cross-sectional study[J].Br J Clin Pharmacol,2018,84(8):1706-1718.
[12]Ejaz AA,Mu W,Kang DH,et al.Could uric acid have a role in acute renal failure[J].Clin J Am Soc Nephrol,2007,2(1):16-21.
[13]Wiedermann CJ,Wiedermann W.Hypoalbuminemia and acute kidney injury:a meta-analysis of observational clinical studies[J].Intensive Care Med,2010,36(10):1657-1665.
[14]沈小菊,曾嘉玮,吴海燕,等.儿科重症患者万古霉素相关急性肾损伤发生状况及危险因素分析[J].药物不良反应杂志,2018,20(2):83-90.
[15]Im DS,Shin HJ,Yang KJ,et al.Cilastatin attenuates vancomycin-induced nephrotoxicity via P-glycoprotein[J].Toxicol Lett,2017,277(5):9-17.
[2]Rybak MJ,Lomaestro BM,Rotschafer JC,et al.Vancomycin therapeutic guidelines:a summary of consensus recommendations from the infectious diseases Society of America,the American Society of Health-System Pharmacists,and the Society of Infectious Diseases Pharmacists[J].Clin Infect Dis,2009,49(3):325-327.
[3]Filippone EJ,Kraft WK.The nephrotoxicity of vancomycin[J].Clin Pharmacol Ther,2017,102(3):459-469.
[4]Costa e Silva VT,Marcal LJ.Risk factors for vancomycin nephrotoxicity:still a matter of debate[J].Crit Care Med,2014,42(12):2635-2636.
[5]Stevens PE,Levin A.Evaluation and management of chronic kidney disease:synopsis of the kidney disease:improving global outcomes 2012 clinical practice guideline[J].Ann Intern Med,2013,158(11):825-830.
[6]Elyasi S,Khalili H,Dashti-Khavidaki S,et al.Vancomycin-induced nephrotoxicity:mechanism,incidence,risk factors and special populations.A literature review[J].Eur J Clin Pharmacol,2012,68(9):1243-1255.
[7]罗洁,徐芬,丁岚.万古霉素对大鼠肾小管上皮细胞肾损伤定量评价及其机制研究[J].江西医药,2018,53(1):26-28.
[8]Jin J,Li M,Zhao Z,et al.Protective effect of Wuzhi tablet(Schisandra sphenanthera extract)against cisplatin-induced nephrotoxicity via Nrf2-mediated defense response[J].Phymed,2015,22(5):528-535.
[9]Revilla N,Martín-Suárez A,Pérez MP,et al.Vancomycin dosing assessment in intensive care unit patients based on a population pharmacokinetic/pharmacodynamic simulation[J].Br J Clin Pharmacol,2010,70(2):201-212.
[10]阮浩澜,陈琪,黎旸,等.基于狗肾小管上皮细胞的雷公藤甲素体外肾毒性研究[J].中国药师,2015,18(1):1-4.
[11]Pan KM,Wu Y,Chen C,et al.Vancomycin-induced acute kidney injury in elderly Chinese patients:a single-centre cross-sectional study[J].Br J Clin Pharmacol,2018,84(8):1706-1718.
[12]Ejaz AA,Mu W,Kang DH,et al.Could uric acid have a role in acute renal failure[J].Clin J Am Soc Nephrol,2007,2(1):16-21.
[13]Wiedermann CJ,Wiedermann W.Hypoalbuminemia and acute kidney injury:a meta-analysis of observational clinical studies[J].Intensive Care Med,2010,36(10):1657-1665.
[14]沈小菊,曾嘉玮,吴海燕,等.儿科重症患者万古霉素相关急性肾损伤发生状况及危险因素分析[J].药物不良反应杂志,2018,20(2):83-90.
[15]Im DS,Shin HJ,Yang KJ,et al.Cilastatin attenuates vancomycin-induced nephrotoxicity via P-glycoprotein[J].Toxicol Lett,2017,277(5):9-17.