血清Cys-C及尿KIM-1评价老年患者使用万古霉素致急性肾损伤的回顾性研究
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摘要
目的:利用血清半胱氨酸蛋白酶抑制剂C(Cys-C)、肌酐(Cr),尿液肾损伤因子1(KIM-1)评价使用万古霉素老年患者致急性肾损伤,为临床药师协助临床医师制定个体化给药方案提供理论依据。方法:回顾性收集2016年7月~2017年5月入住我院ICU使用万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)血流感染的老年患者48例,统计万古霉素治疗前和用药后6,12,24,48h患者血清Cys-C、Cr,尿KIM-1检测数据。根据AKI诊断标准将患者分为AKI组和对照组。比较两组患者用药后血清Cr、Cys-C、尿KIM-1水平差异,绘制受试者工作特征曲线(ROC)评价Cys-C、KIM-1的临床诊断价值。结果:使用万古霉素48 h后,有32例(66.67%)患者发生AKI。与对照组相比,AKI组患者血清Cr于用药后48 h、Cys-C于用药后24h、尿KIM-1于用药后12 h开始显著上升(P<0.05)。利用血清Cys-C、Cr及尿KIM-1分别进行AKI诊断时,在用药后12 h诊断发生AKI的人数差异有统计学意义(P<0.05)。ROC曲线分析结果显示:尿KIM-1曲线下面积(AUC 0.797,95%可信区间:0.647~0.947),血清Cys-C曲线下面积(AUC 0.582,95%可信区间:0.364~0.799)。结论:与传统肾损标志物Cr相比,血清Cys-C及尿KIM-1可更早地预判老年患者肾功能情况,为肾功能的早期评估提供可靠依据,有助于临床药师利用有效指标协助临床医师及时调整老年患者万古霉素给药方案。
Objective: To evaluate acute kidney injure( AKI) induced by vancomycin in elderly patients by the determination of serum C( Cys-C),creatinine( Cr) and urine kidney damage factor 1( KIM-1) in order to provide theoretical evidence for clinical pharmacists helping clinicians make individualized dosage regimen. Methods: A retrospective collection of 48 elderly patients admitted to ICU in our hospital from July 2016 to May 2017 treated with vancomycin for MRSA blood flow infection was carried out. The basic values of serum Cys-C,Cr and urine KIM-1 were determined before the treatment of vancomycin and 6,12,24 h and 48 h after the drug use. According to the AKI diagnostic criteria,the patients were divided into the AKI experimental group and the control group. The serum Cr,Cys-C and urine KIM-1 were compared between the groups after the drug use and the clinical diagnostic values of Cys-C and KIM-1 were assessed by the working characteristic curve ROC of the subjects. Results: Totally 32 cases( 66. 67%) of patients were with AKI induced by vancomycin at 48 h after the administration. Compared with that of the control group,the serum Cr,Cys-C and urine KIM-1 was significantly higher respectively at 48 h,24 h and 12 h after the drug use in the AKI experimental group,and the differences between the groups were statistically significant( P < 0. 05). Using serum Cys-C,Cr and urine KIM-1 as the AKI diagnosis,the number of AKI at 12 h after the drug use had statistically significant difference( P < 0. 05). The results of ROC curve analysis showed that the area under the KIM-1 curve of urine was 0. 797 with 95% confidence interval of 0. 647-0. 947),and the area under the serum Cys-c curve was 0. 582 with 95% confidence interval of 0. 364-0. 799. Conclusion: Compared with the traditional kidney damage markers Cr,serum Cys-C and urine KIM-1 can earlier predict renal function in elderly patients to provide reliable basis for early evaluation of renal function,which is helpful to the timely adjustment of vancomycin dosage regimen by clinicians assisted by clinical pharmacists for elderly patients.
Objective: To evaluate acute kidney injure( AKI) induced by vancomycin in elderly patients by the determination of serum C( Cys-C),creatinine( Cr) and urine kidney damage factor 1( KIM-1) in order to provide theoretical evidence for clinical pharmacists helping clinicians make individualized dosage regimen. Methods: A retrospective collection of 48 elderly patients admitted to ICU in our hospital from July 2016 to May 2017 treated with vancomycin for MRSA blood flow infection was carried out. The basic values of serum Cys-C,Cr and urine KIM-1 were determined before the treatment of vancomycin and 6,12,24 h and 48 h after the drug use. According to the AKI diagnostic criteria,the patients were divided into the AKI experimental group and the control group. The serum Cr,Cys-C and urine KIM-1 were compared between the groups after the drug use and the clinical diagnostic values of Cys-C and KIM-1 were assessed by the working characteristic curve ROC of the subjects. Results: Totally 32 cases( 66. 67%) of patients were with AKI induced by vancomycin at 48 h after the administration. Compared with that of the control group,the serum Cr,Cys-C and urine KIM-1 was significantly higher respectively at 48 h,24 h and 12 h after the drug use in the AKI experimental group,and the differences between the groups were statistically significant( P < 0. 05). Using serum Cys-C,Cr and urine KIM-1 as the AKI diagnosis,the number of AKI at 12 h after the drug use had statistically significant difference( P < 0. 05). The results of ROC curve analysis showed that the area under the KIM-1 curve of urine was 0. 797 with 95% confidence interval of 0. 647-0. 947),and the area under the serum Cys-c curve was 0. 582 with 95% confidence interval of 0. 364-0. 799. Conclusion: Compared with the traditional kidney damage markers Cr,serum Cys-C and urine KIM-1 can earlier predict renal function in elderly patients to provide reliable basis for early evaluation of renal function,which is helpful to the timely adjustment of vancomycin dosage regimen by clinicians assisted by clinical pharmacists for elderly patients.
引文
1肖永红.美国感染病学会耐甲氧西林金黄色葡萄球菌感染治疗指南要点[J].中国医学前沿杂志,2011,2(3):53-56
2 Sanford JP.美国桑福德抗微生物治疗指南[M].第44版.北京:中国协和医科大学出版社,2014:65
3 Arimura Y,Yano T,Hirano M,et al.Mitochondrial superoxide production contributes tovancomycin-inducedrenal tubular cell apoptosis[J].Free Radic Biol Med,2012,52(9):1865-1873
4 Moh DH,Khei RF,Kong L,et al.Incidence and predictors of vancomycin-associated nephrotoxicity[J].South Med J,2014,107(6):383-388
5 Dieterich C,Puey A,Lin S,et al.Gene expression analysis reveals new possible mechanisms of vancomycin-induced nephrotoxieity and ideritifies gene markers candidates[J].Toxicol Sci,2009,107(l):258-269
6 李俊,周甘平,陈媛媛.肾损害标志物在万古霉素治疗老年患者耐甲氧西林金黄色葡萄球菌血流感染中的应用价值[J].中国药业,2016,25(17):1-4
7 李瑾,殷少军,李微,等.血清胱抑素C、尿微量蛋白联合检测在万古霉素致早期肾损害中的应用[J].实用药物与临床,2012,5(15):277-280
8 朱聪,黄芝瑛,周晓冰,等.肾毒性生物标志物临床前研究及应用进展[J].中国新药杂志,2014,23(4):391-396
9 Dhaxnidharka VR,Kwon C,Stevens G.Serum Cystatin C issuperior to serum creatinineasa marker of kidney function:ameta-analysis[J].Am JK idney Dis,2002,40:221-226
10 赵夕岚,董芊汝,陈恳,等.万古霉素首剂给予负荷剂量对临床结局影响的系统评价[J].药物流行病学杂志,2015,24(5):257-260
11 张小丹,邵菁菁,潘春晓,等.肿瘤专科医院66例患者万古霉素使用的专项点评[J].中国药师,2017,20(1):109-112
2 Sanford JP.美国桑福德抗微生物治疗指南[M].第44版.北京:中国协和医科大学出版社,2014:65
3 Arimura Y,Yano T,Hirano M,et al.Mitochondrial superoxide production contributes tovancomycin-inducedrenal tubular cell apoptosis[J].Free Radic Biol Med,2012,52(9):1865-1873
4 Moh DH,Khei RF,Kong L,et al.Incidence and predictors of vancomycin-associated nephrotoxicity[J].South Med J,2014,107(6):383-388
5 Dieterich C,Puey A,Lin S,et al.Gene expression analysis reveals new possible mechanisms of vancomycin-induced nephrotoxieity and ideritifies gene markers candidates[J].Toxicol Sci,2009,107(l):258-269
6 李俊,周甘平,陈媛媛.肾损害标志物在万古霉素治疗老年患者耐甲氧西林金黄色葡萄球菌血流感染中的应用价值[J].中国药业,2016,25(17):1-4
7 李瑾,殷少军,李微,等.血清胱抑素C、尿微量蛋白联合检测在万古霉素致早期肾损害中的应用[J].实用药物与临床,2012,5(15):277-280
8 朱聪,黄芝瑛,周晓冰,等.肾毒性生物标志物临床前研究及应用进展[J].中国新药杂志,2014,23(4):391-396
9 Dhaxnidharka VR,Kwon C,Stevens G.Serum Cystatin C issuperior to serum creatinineasa marker of kidney function:ameta-analysis[J].Am JK idney Dis,2002,40:221-226
10 赵夕岚,董芊汝,陈恳,等.万古霉素首剂给予负荷剂量对临床结局影响的系统评价[J].药物流行病学杂志,2015,24(5):257-260
11 张小丹,邵菁菁,潘春晓,等.肿瘤专科医院66例患者万古霉素使用的专项点评[J].中国药师,2017,20(1):109-112