Schwartz公式计算所得的儿童肾小球滤过率和万古霉素理想剂量之间的相关性研究
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摘要
目的:了解Schwartz公式计算所得到的儿童肾小球滤过率(GFR)和万古霉素理想剂量之间的关联性。评估是否可以通过GFR估算出万古霉素的理想剂量。方法:通过治疗药物监测,计算出患儿万古霉素的清除率和理想日剂量。依据患儿血肌酐值,以Schwartz公式计算所得GFR值,观察不同GFR值范围内相对应的万古霉素日剂量分布,并采用线性回归分析法,评价GFR和上述药动学参数的相关性。结果:GFR值超过200 ml·min-1·(1.73m2)-1时,72.22%的患者理想剂量>60mg·kg-1·d-1;线性回归分析结果,GFR对于清除率和理想日剂量之间存在统计学意义上的线性关系,但其回归系数R2分别仅为0.307和0.361,GFR和理想日剂量之间的回归方程为Y=0.169X+29.577。结论:由Schwartz公式所得的GFR值和万古霉素理想日剂量之间存在着统计学意义上的的线性关系,但是其相关性强度不高,无法用来准确估算万古霉素剂量。
Objective: To evaluate the correlation between glomerular filtration rate( GFR) calculated by Schwartz equation and vancomycin dosage in children to decide whether GFR can be used to estimate the dosage of vancomycin. Methods: The CL and ideal daily dosage of vancomycin were calculated by TDM method,the patient's GFR was calculated using serum creatinine by Schwartz equation,and the correlation between GFR and CL,ideal daily dosage was evaluated by using linear regression analysis. Results:When the GFR values above 200 ml·min-1·( 1. 73 m2)-1,the ideal daily dosage for 77. 22% patients was above 60 mg·kg-1·d-1. According to the linear regression analysis,the GFR had statistical correlation with the CL and ideal daily dosage of vancomycin in the whole research population,and the regression coefficient R2 was 0. 307 and 0. 361,respectively. The regression equation for the GFR and the ideal daily dosage was Y = 0. 169 X + 29. 577. Conclusion: The GFR calculated by Schwartz equation shows statistical correlation with CL and ideal daily dosage of vancomycin,however,the correlation is not strong enough to calculate the exact dose of vancomycin.
Objective: To evaluate the correlation between glomerular filtration rate( GFR) calculated by Schwartz equation and vancomycin dosage in children to decide whether GFR can be used to estimate the dosage of vancomycin. Methods: The CL and ideal daily dosage of vancomycin were calculated by TDM method,the patient's GFR was calculated using serum creatinine by Schwartz equation,and the correlation between GFR and CL,ideal daily dosage was evaluated by using linear regression analysis. Results:When the GFR values above 200 ml·min-1·( 1. 73 m2)-1,the ideal daily dosage for 77. 22% patients was above 60 mg·kg-1·d-1. According to the linear regression analysis,the GFR had statistical correlation with the CL and ideal daily dosage of vancomycin in the whole research population,and the regression coefficient R2 was 0. 307 and 0. 361,respectively. The regression equation for the GFR and the ideal daily dosage was Y = 0. 169 X + 29. 577. Conclusion: The GFR calculated by Schwartz equation shows statistical correlation with CL and ideal daily dosage of vancomycin,however,the correlation is not strong enough to calculate the exact dose of vancomycin.
引文
1 Fainareti NZ,Ioannis MZ,Panayiotis DZ,et al.MRSA colonization and risk of infection in the neonatal and pediatric ICU:a meta-analysis[J].Pediatrics,2014,133(4):1015-1023
2 朱卫江,姜文燕,蒋玉凤,等.ICU患者万古霉素血药浓度监测与个体化给药方案调整[J].中国药师,2017,20(8):1437-1439
3 Rybak MJ,Lomaestro BM,Rotschafer JC,et al.Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists,the Infection Diseases Society of America,and the Society of Infectious Disease Pharmacists[J].Pharmacotherapy,2009,29(11):1275-1279
4 Schwartz GJ,Munoz A,Schneider MF,et al.New equations to estimate GFR in children in CKD[J].J Am Soc Nephrol,2009,20(3):629-637
5 高雅婷,张峰英,王雷鸣,等.万古霉素血药浓度监测的临床应用[J].中国感染与化疗杂志,2014,14(6):526-531
6 Yamamoto T,Terakawa H,Hisaka A,et al.Bayesian estimation of pharmacokinetic parameters of vancomycin in patients with decreasing renal function[J].J Pharm Sci,2012,101(8):2968-2975
7 Matzke GR,Kovarik JM,Rybak MJ,et al.Evaluation of vancomycinclearance:creatinine-clearance relationship for predicting vancomycin dosage[J].Clin Pharm,1985,4(3):311-315
8 Kullar R,Leonard SN,Davis SL,et al.Validation of the effectiveness of a vancomycin nomogram in achieving target trough concentrations of 15-20 mg/L suggested by the vancomycin consensus guidelines[J].Pharmacotherapy,2011,31(5):441-448
9 Stevens LA,Coresh J,Greene T,et al.Assessing kidney functionmeasured and estimated glomerular filtration rate[J].N Engl J Med,2006,354(23):2473-2483
2 朱卫江,姜文燕,蒋玉凤,等.ICU患者万古霉素血药浓度监测与个体化给药方案调整[J].中国药师,2017,20(8):1437-1439
3 Rybak MJ,Lomaestro BM,Rotschafer JC,et al.Therapeutic monitoring of vancomycin in adults summary of consensus recommendations from the American Society of Health-System Pharmacists,the Infection Diseases Society of America,and the Society of Infectious Disease Pharmacists[J].Pharmacotherapy,2009,29(11):1275-1279
4 Schwartz GJ,Munoz A,Schneider MF,et al.New equations to estimate GFR in children in CKD[J].J Am Soc Nephrol,2009,20(3):629-637
5 高雅婷,张峰英,王雷鸣,等.万古霉素血药浓度监测的临床应用[J].中国感染与化疗杂志,2014,14(6):526-531
6 Yamamoto T,Terakawa H,Hisaka A,et al.Bayesian estimation of pharmacokinetic parameters of vancomycin in patients with decreasing renal function[J].J Pharm Sci,2012,101(8):2968-2975
7 Matzke GR,Kovarik JM,Rybak MJ,et al.Evaluation of vancomycinclearance:creatinine-clearance relationship for predicting vancomycin dosage[J].Clin Pharm,1985,4(3):311-315
8 Kullar R,Leonard SN,Davis SL,et al.Validation of the effectiveness of a vancomycin nomogram in achieving target trough concentrations of 15-20 mg/L suggested by the vancomycin consensus guidelines[J].Pharmacotherapy,2011,31(5):441-448
9 Stevens LA,Coresh J,Greene T,et al.Assessing kidney functionmeasured and estimated glomerular filtration rate[J].N Engl J Med,2006,354(23):2473-2483