住院患者静脉滴注克林霉素致急性肾损伤危险因素分析
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摘要
目的对住院患者静脉滴注克林霉素致急性肾损伤(AKI)的危险因素进行分析,为临床安全用药提供参考。方法回顾性分析2016年1月至2018年2月我院106例克林霉素致AKI和同期使用克林霉素但未发生AKI的1 151例患者的临床资料,采用单因素(χ~2检验)及多因素(Logistic回归)对肾毒性危险因素进行分析。结果 AKI是克林霉素严重不良反应之一,其发生率为8. 43%。单因素分析显示,患者年龄、APACHEⅡ评分、入住ICU、肌酐清除率、血清白蛋白、合并呼吸衰竭、联用利尿剂、联用质子泵抑制剂、联用抗真菌药、克林霉素不同酸根、克林霉素药物浓度和克林霉素用药时间与AKI相关。多因素分析显示,克林霉素药物浓度(> 0. 6g/100 ml)、APACHEⅡ评分(≥20分)、克林霉素用药时间(≥7 d)、肌酐清除率(≤30 ml/min)、联用质子泵抑制剂、血清白蛋白(<30 g/L)、合并呼吸衰竭、入住ICU、联用利尿剂和年龄(≥65岁)是克林霉素引起AKI的独立危险因素。大部分AKI患者转归较好,无继发严重肾功能衰竭或尿毒症患者。结论临床实践中应重点关注有独立危险因素的患者,以保证克林霉素临床安全用药。
Objective To investigate the risk factors for acute kidney injury( AKI) induced by intravenous infusion of clindamycin in inpatients,and to provide reference for clinical safe drug use. Methods The clinical data of106 cases of clindamycin-induced AKI and 1 511 cases who were given clindamycin but did not demonstrate AKI in our hospital fromJanuary 2016 to February 2018 were retrospectively analyzed. The risk factors of nephrotoxicity were analyzed by univariate( χ~2test) and multiple factors( Logistic regression). Results AKI was one of the serious ADR of clindamycin,and its incidence rate was 8. 43%. Univariate analysis showed that the patient' s age,APACHEⅡ score,stay in ICU,creatinine clearance rate,serumalbumin,being combined with respiratory failure,combination use of diuretics,combination use of proton pump inhibitors,combination use of antifungal agents,different acid ions of cllincomycin,clindamycin concentration and clindamycin administration time were correlated with AKI. M ultiple factors analysis showed that the concentration of clindamycin( > 0. 6 g/100 ml),APACHEⅡ score( ≥20),time of clindamycin use( ≥7 days),creatinine clearance rate( < 30 ml/min),combination use of proton pump inhibitors,serumalbumin( <30 g/L),being combined with respiratory failure,stay in ICU,combination use of diuretics and patient' s age( ≥65years) were independent risk factors for clindamycin-induced AKI. M ost of the AKI patients had better outcomes without secondary severe renal failure or uremia. Conclusion Clinical practice should focus on patients with independent risk factors in order to ensure the clinical safe use of clindamycin.
Objective To investigate the risk factors for acute kidney injury( AKI) induced by intravenous infusion of clindamycin in inpatients,and to provide reference for clinical safe drug use. Methods The clinical data of106 cases of clindamycin-induced AKI and 1 511 cases who were given clindamycin but did not demonstrate AKI in our hospital fromJanuary 2016 to February 2018 were retrospectively analyzed. The risk factors of nephrotoxicity were analyzed by univariate( χ~2test) and multiple factors( Logistic regression). Results AKI was one of the serious ADR of clindamycin,and its incidence rate was 8. 43%. Univariate analysis showed that the patient' s age,APACHEⅡ score,stay in ICU,creatinine clearance rate,serumalbumin,being combined with respiratory failure,combination use of diuretics,combination use of proton pump inhibitors,combination use of antifungal agents,different acid ions of cllincomycin,clindamycin concentration and clindamycin administration time were correlated with AKI. M ultiple factors analysis showed that the concentration of clindamycin( > 0. 6 g/100 ml),APACHEⅡ score( ≥20),time of clindamycin use( ≥7 days),creatinine clearance rate( < 30 ml/min),combination use of proton pump inhibitors,serumalbumin( <30 g/L),being combined with respiratory failure,stay in ICU,combination use of diuretics and patient' s age( ≥65years) were independent risk factors for clindamycin-induced AKI. M ost of the AKI patients had better outcomes without secondary severe renal failure or uremia. Conclusion Clinical practice should focus on patients with independent risk factors in order to ensure the clinical safe use of clindamycin.
引文
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[3]国家食品药品监督管理局.警惕克林霉素注射剂的严重不良反应,关注藻酸双酯钠注射剂的严重不良反应[EB/OL].(2009-03-24). http://w w w. sfda. gov. cn/WS01/CL0078/36756. html.
[4]赵震华.静脉用克林霉素发生急性肾衰竭的Logistic回归分析及防治措施[J].中国医院药学杂志,2013,33(21):1807-1808.
[5]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.
[6] Minejima E,Choi J,Beringer P,et al. Applying new diagnostic criteria for acute kidney injury to facilitate early identification of nephrotoxicity in vancomycin-treated patients[J]. Antimicrob Agents Chemother,2011,55(7):3278-3283.
[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]涂岩.急性肾损伤患者危险因素及预后的分析[D].东南大学,2016.
[9]阮玉玲,何玉明.克林霉素致肾毒性不良反应10例分析[J].临床合理用药杂志,2014,7(6):133-134.
[10]邱波,解华,田月洁.盐酸克林霉素和克林霉素磷酸酯致肾损害的比较[J].中国抗生素杂志,2013,38(6):476-479.
[11]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):247-252.
[12]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分析[J].中国医院药学杂志,2016,36(8):647-650.
[13]唐文庄,文海燕,王彧.质子泵抑制剂致急性间质性肾炎的临床及病理特征分析[J].重庆医学,2015,44(23):3271-3272.
[14]孟瑞琴.慢性肾脏疾病合并急性肾损伤的危险因素及预后分析[D].兰州大学,2017.
[15]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.
[16]刘思. 236例药物相关急性肾损伤的临床和病理分析[D].吉林大学,2016.
[17]戈梦佳,陈恳,马青变,等.利奈唑胺相关血小板减少危险因素的Meta分析[J].药物不良反应杂志,2016,18(6):405-411.
[18]王俊锋. 2010-2014年克林霉素致急性肾损伤文献调查研究[J].临床误诊误治,2015,28(10):62-65.
[2]朱曼,蔡乐,郭代红,等. 209例抗感染药物药源性肾损伤不良反应/事件报告分析[J].药物流行病学杂志,2015,24(9):537-540.
[3]国家食品药品监督管理局.警惕克林霉素注射剂的严重不良反应,关注藻酸双酯钠注射剂的严重不良反应[EB/OL].(2009-03-24). http://w w w. sfda. gov. cn/WS01/CL0078/36756. html.
[4]赵震华.静脉用克林霉素发生急性肾衰竭的Logistic回归分析及防治措施[J].中国医院药学杂志,2013,33(21):1807-1808.
[5]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.
[6] Minejima E,Choi J,Beringer P,et al. Applying new diagnostic criteria for acute kidney injury to facilitate early identification of nephrotoxicity in vancomycin-treated patients[J]. Antimicrob Agents Chemother,2011,55(7):3278-3283.
[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]涂岩.急性肾损伤患者危险因素及预后的分析[D].东南大学,2016.
[9]阮玉玲,何玉明.克林霉素致肾毒性不良反应10例分析[J].临床合理用药杂志,2014,7(6):133-134.
[10]邱波,解华,田月洁.盐酸克林霉素和克林霉素磷酸酯致肾损害的比较[J].中国抗生素杂志,2013,38(6):476-479.
[11]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):247-252.
[12]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分析[J].中国医院药学杂志,2016,36(8):647-650.
[13]唐文庄,文海燕,王彧.质子泵抑制剂致急性间质性肾炎的临床及病理特征分析[J].重庆医学,2015,44(23):3271-3272.
[14]孟瑞琴.慢性肾脏疾病合并急性肾损伤的危险因素及预后分析[D].兰州大学,2017.
[15]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.
[16]刘思. 236例药物相关急性肾损伤的临床和病理分析[D].吉林大学,2016.
[17]戈梦佳,陈恳,马青变,等.利奈唑胺相关血小板减少危险因素的Meta分析[J].药物不良反应杂志,2016,18(6):405-411.
[18]王俊锋. 2010-2014年克林霉素致急性肾损伤文献调查研究[J].临床误诊误治,2015,28(10):62-65.