静脉滴注万古霉素致中国人群急性肾损伤危险因素的系统评价
|
摘要
目的:系统评价静脉滴注万古霉素致中国人群急性肾损伤的危险因素。方法:计算机检索建库起至2017年12月发表于Pub Med、Embase、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库、中国生物医学数据库、万方等相关数据库中有关静脉滴注万古霉素致中国人群急性肾损伤危险因素的病例对照研究,对符合纳入标准的文献进行资料提取,并采用纽卡斯尔-渥太华质量评估量表(NOS)对纳入文献进行质量评价后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入11项研究,合计1 378例患者,涉及20个相关因素,其中11个因素差异有统计学意义(P<0.05):患者基本情况,包括体质量偏低[MD=-2.19,95%CI(-4.03,-0.35),P=0.020],入住重症监护治疗病房(ICU)[OR=2.52,95%CI(1.33,4.78),P=0.005],肌酐清除率偏低[MD=-17.43,95%CI(-20.76,-14.10),P<0.001]、急性生理和慢性健康评分Ⅱ(APACHE-Ⅱ)评分偏高[MD=4.13,95%CI(2.44,5.82),P<0.001];合并基础疾病,包括呼吸衰竭[OR=4.07,95%CI(2.59,6.40),P<0.001]、严重心血管疾病[OR=2.01,95%CI(1.34,3.02),P=0.007];联合用药,包括利尿药[OR=2.97,95%CI(2.15,4.11),P<0.001]、血管升压药[OR=4.48,95%CI(2.63,7.62),P<0.001],血管紧张素转换酶抑制药或血管紧张素Ⅱ受体阻断药[OR=1.84,95%CI(1.17,2.90),P=0.009];万古霉素用药情况,包括用药时间偏长[MD=2.03,95%CI(0.90,3.15),P=0.004]和谷浓度偏高[MD=8.11,95%CI(5.38,10.85),P<0.001]。结论:患者体质量偏低、入住ICU、用药前肌酐清除率偏低、APACHE-Ⅱ评分偏高、呼吸衰竭、合并利尿剂或血管升压药等、万古霉素用药时间偏长和谷浓度偏高是万古霉素致急性肾损伤的危险因素,患者存在上述情况时应谨慎用药,关注急性肾损伤的发生。
OBJECTIVE:To evaluate the risk factors for intravenous dripping of vancomycin-induced acute kidney injury(AKI)in Chinese patients. METHODS:The case-control studies about risk factors for intravenous dripping of vancomycin-induced AKI were retrieved from Pub Med, Embase, Cochrane library, CNKI, VIP, CBM and Wanfang database during database establishment to Dec. 2017. The data of included literatures was extracted. After quality evaluation was carried out with Newcastle Ottawa quality assessment scale,Meta-analysis was conducted by using Rev Man 5.2 software. RESULTS:A total of 11 studies were included,involving 1 378 patients. 20 risk factors were involved,11 of which were significantly different(P<0.05). General information of patients included low body weight [MD=-2.19,95% CI(-4.03,-0.35),P=0.020],intensive care unit(ICU)admission [OR=2.52,95%CI(1.33,4.78),P=0.005],low creatinine clearance rate [MD=-17.43,95%CI(-20.76,-14.10),P<0.001],high acute physiological and chronic health score Ⅱ(APACHE-Ⅱ)score [MD=4.13,95% CI(2.44,5.82),P<0.001];combined primary diseases included respiratory failure [OR=4.07,95% CI=2.59,6.40,P<0.001] and severe cardiovascular disease [OR=2.01,95% CI(1.34,3.02),P=0.007];drug combination included diuretic [OR=2.97,95% CI(2.15,4.11),P<0.001],vasopressor agent [OR=4.48,95%CI(2.63,7.62),P<0.001] and ACEI or ARB [OR=1.84,95%CI(1.17,2.90),P=0.009];vancomycin use included long medication time [MD=2.03,95%CI(0.90,3.15),P=0.004] and high trough concentration[MD=8.11,95%CI(5.38,10.85),P<0.001]. CONCLUSIONS:Low body weight,ICU admission,low creatinine clearance rate,high APACHE-Ⅱ score,respiratory failure,combined with diuretics or vasopressors agent,long medication time and high trough concentration are the risk factors for vancomycininduced AKI.
OBJECTIVE:To evaluate the risk factors for intravenous dripping of vancomycin-induced acute kidney injury(AKI)in Chinese patients. METHODS:The case-control studies about risk factors for intravenous dripping of vancomycin-induced AKI were retrieved from Pub Med, Embase, Cochrane library, CNKI, VIP, CBM and Wanfang database during database establishment to Dec. 2017. The data of included literatures was extracted. After quality evaluation was carried out with Newcastle Ottawa quality assessment scale,Meta-analysis was conducted by using Rev Man 5.2 software. RESULTS:A total of 11 studies were included,involving 1 378 patients. 20 risk factors were involved,11 of which were significantly different(P<0.05). General information of patients included low body weight [MD=-2.19,95% CI(-4.03,-0.35),P=0.020],intensive care unit(ICU)admission [OR=2.52,95%CI(1.33,4.78),P=0.005],low creatinine clearance rate [MD=-17.43,95%CI(-20.76,-14.10),P<0.001],high acute physiological and chronic health score Ⅱ(APACHE-Ⅱ)score [MD=4.13,95% CI(2.44,5.82),P<0.001];combined primary diseases included respiratory failure [OR=4.07,95% CI=2.59,6.40,P<0.001] and severe cardiovascular disease [OR=2.01,95% CI(1.34,3.02),P=0.007];drug combination included diuretic [OR=2.97,95% CI(2.15,4.11),P<0.001],vasopressor agent [OR=4.48,95%CI(2.63,7.62),P<0.001] and ACEI or ARB [OR=1.84,95%CI(1.17,2.90),P=0.009];vancomycin use included long medication time [MD=2.03,95%CI(0.90,3.15),P=0.004] and high trough concentration[MD=8.11,95%CI(5.38,10.85),P<0.001]. CONCLUSIONS:Low body weight,ICU admission,low creatinine clearance rate,high APACHE-Ⅱ score,respiratory failure,combined with diuretics or vasopressors agent,long medication time and high trough concentration are the risk factors for vancomycininduced AKI.
引文
[1]吴建浓,施敏凤,王灵聪.万古霉素治疗葡萄球菌肺炎的疗效和肾毒性评价[J].中国新药与临床杂志,2005,24(3):245-248.
[2]VANHAL SJ,PATERON DL,LODISE TP.Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter[J].Antimicrob Agents Chemother,2013,57(2):734-744.
[3]BOSSO JA,NAPPI J,RUDISILL C,et al.Relationship between vancomycin through concentration and nephrotoxicity:a prospective multicenter trial[J].Antimicrob Agents Chemother,2011,55(12):5475-5479.
[4]MINEJIMA E,CHOI J,BERINGER P,et al.Applying new diagonsitc criteria for acute kidney injury to facilitate early identification of nephrotoxicity in vancomycin-treated patients[J].Antimicrob Agents Chemother,2011,55(7):3278-3283.
[5]STANG A.Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-615.
[6]LIU Y,YIN Y,LIU XZ,et al.Retrospective analysis of vancomycin nephrotoxicity in elderly Chinese patients[J].Pharmacology,2015,95(5):279-284.
[7]潘坤明,马凌云,向倩,等.老年人群万古霉素相关急性肾损伤现状调查及其风险因素[J].中国新药杂志,2017,26(15):1848-1856.
[8]张海燕,朱春香,罗万慰,等.万古霉素相关急性肾损伤的危险因素分析[J].中国医院药学杂志,2016,36(6):503-507.
[9]陈春燕,朱素燕,周科挺,等.万古霉素谷浓度预测重症肺炎疗效及肾毒性的回顾性分析[J].中国现代应用药学,2016,33(9):1188-1195.
[10]马雪,蒋刚,蒋倩,等.重症感染肿瘤患者使用万古霉素致相关肾功能不全的危险因素[J].中国医院药学杂志,2016,36(8):647-651.
[11]曲连悦,李紫璇,初阳,等.万古霉素相关肾毒性危险因素分析[J].中国医院药学杂志,2016,36(14):1216-1219.
[12]蔡云东,费爱华.万古霉素血药浓度监测和肾毒性及临床疗效关系的研究[J].现代中西医结合杂志,2016,25(29):3199-3202.
[13]李刚,朱以翠,黎庆萍.万古霉素相关肾毒性的观察及血药浓度监测的意义[J].中国生化药物杂志,2015,35(3):85-89.
[14]黄敏,周静,毕立清,等.80岁以上高龄重症患者使用万古霉素的安全性分析[J].中华老年多器官疾病杂志,2015,14(4):247-253.
[15]牛晓蓉.重症感染患者万古霉素相关急性肾损伤的临床特点及危险因素分析[J].中外健康文摘,2014(20):93-95.
[16]刘艳萍,董伟,段崇浩,等.万古霉素对MRSA感染的呼吸机相关性肺炎患者肾功能的影响[J].医学理论与实践,2016,29(10):1266-1268.
[17]万古霉素临床应用中国专家共识(2011年版)[J].中国新药与临床杂志,2011,30(8):561-573.
[18]王秋雁,何瑾,王晶晶,等.万古霉素不同给药方式所致肾毒性[J].中国医院药学杂志,2017,37(11):1018-1111.
[19]林汉云,王成林,蒋中君,等.万古霉素鞘内注射与静脉滴注治疗颅内感染临床疗效及安全性的Meta分析[J].实用心脑肺病杂志,2017,24(4):7-11.
[20]李雪,赵文静,臧宝赫,等.万古霉素2种不同静脉给药方案的疗效及肾毒性的分析[J].中国现代医学杂志,2017,25(7):85-89.
[21]ELYASI S,KHALILI H,DASHTI K,et al.Vancomycinnduced nephrotoxicity:mechanism,incidence,risk factors and special populations:a literature review[J].Eur J Clin Pharmacol,2012,68(9):1243-1255.
[22]LODISE TP,PATEL N,LOMAESTRO BM,et al.Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients[J].Clin Infect Dis,2009,49(4):507-514.
[2]VANHAL SJ,PATERON DL,LODISE TP.Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter[J].Antimicrob Agents Chemother,2013,57(2):734-744.
[3]BOSSO JA,NAPPI J,RUDISILL C,et al.Relationship between vancomycin through concentration and nephrotoxicity:a prospective multicenter trial[J].Antimicrob Agents Chemother,2011,55(12):5475-5479.
[4]MINEJIMA E,CHOI J,BERINGER P,et al.Applying new diagonsitc criteria for acute kidney injury to facilitate early identification of nephrotoxicity in vancomycin-treated patients[J].Antimicrob Agents Chemother,2011,55(7):3278-3283.
[5]STANG A.Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses[J].Eur J Epidemiol,2010,25(9):603-615.
[6]LIU Y,YIN Y,LIU XZ,et al.Retrospective analysis of vancomycin nephrotoxicity in elderly Chinese patients[J].Pharmacology,2015,95(5):279-284.
[7]潘坤明,马凌云,向倩,等.老年人群万古霉素相关急性肾损伤现状调查及其风险因素[J].中国新药杂志,2017,26(15):1848-1856.
[8]张海燕,朱春香,罗万慰,等.万古霉素相关急性肾损伤的危险因素分析[J].中国医院药学杂志,2016,36(6):503-507.
[9]陈春燕,朱素燕,周科挺,等.万古霉素谷浓度预测重症肺炎疗效及肾毒性的回顾性分析[J].中国现代应用药学,2016,33(9):1188-1195.
[10]马雪,蒋刚,蒋倩,等.重症感染肿瘤患者使用万古霉素致相关肾功能不全的危险因素[J].中国医院药学杂志,2016,36(8):647-651.
[11]曲连悦,李紫璇,初阳,等.万古霉素相关肾毒性危险因素分析[J].中国医院药学杂志,2016,36(14):1216-1219.
[12]蔡云东,费爱华.万古霉素血药浓度监测和肾毒性及临床疗效关系的研究[J].现代中西医结合杂志,2016,25(29):3199-3202.
[13]李刚,朱以翠,黎庆萍.万古霉素相关肾毒性的观察及血药浓度监测的意义[J].中国生化药物杂志,2015,35(3):85-89.
[14]黄敏,周静,毕立清,等.80岁以上高龄重症患者使用万古霉素的安全性分析[J].中华老年多器官疾病杂志,2015,14(4):247-253.
[15]牛晓蓉.重症感染患者万古霉素相关急性肾损伤的临床特点及危险因素分析[J].中外健康文摘,2014(20):93-95.
[16]刘艳萍,董伟,段崇浩,等.万古霉素对MRSA感染的呼吸机相关性肺炎患者肾功能的影响[J].医学理论与实践,2016,29(10):1266-1268.
[17]万古霉素临床应用中国专家共识(2011年版)[J].中国新药与临床杂志,2011,30(8):561-573.
[18]王秋雁,何瑾,王晶晶,等.万古霉素不同给药方式所致肾毒性[J].中国医院药学杂志,2017,37(11):1018-1111.
[19]林汉云,王成林,蒋中君,等.万古霉素鞘内注射与静脉滴注治疗颅内感染临床疗效及安全性的Meta分析[J].实用心脑肺病杂志,2017,24(4):7-11.
[20]李雪,赵文静,臧宝赫,等.万古霉素2种不同静脉给药方案的疗效及肾毒性的分析[J].中国现代医学杂志,2017,25(7):85-89.
[21]ELYASI S,KHALILI H,DASHTI K,et al.Vancomycinnduced nephrotoxicity:mechanism,incidence,risk factors and special populations:a literature review[J].Eur J Clin Pharmacol,2012,68(9):1243-1255.
[22]LODISE TP,PATEL N,LOMAESTRO BM,et al.Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients[J].Clin Infect Dis,2009,49(4):507-514.