| 摘要: |
| ［摘要］ 目的 分析多黏菌素B血药浓度与急性肾损伤（AKI）发生风险的关联性。方法 回顾性分析2024年4月1日至8月8日在广西壮族自治区人民医院住院并接受多黏菌素B治疗的53例患者的临床资料。于多黏菌素B给药3剂达稳态后、下次给药前30 min时采集静脉血2～3 mL，应用YS EXACT 9900MD质谱仪进行血药浓度测定。分析多黏菌素B联合肾毒性抗生素对患者血清肌酐水平的影响。分析多黏菌素B使用对患者肾功能指标的影响。采用多因素logistic回归分析使用多黏菌素B后发生AKI的影响因素。结果 与未联合使用肾毒性抗生素相比，多黏菌素B联合使用肾毒性抗生素未显著影响患者血清肌酐水平（P>0.05）。在使用多黏菌素B后，患者血清肌酐及尿素水平升高，肌酐清除率降低，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，较高的血药浓度水平是促进多黏菌素B使用后发生AKI的独立危险因素［OR（95%CI）=1.874（1.220～2.879），P=0.004］。受试者工作特征（ROC）曲线分析结果显示，多黏菌素B血药浓度可有效预测AKI发生［AUC（95%CI）=0.734（0.599～0.868），P=0.004］，其最佳截断值为3.18 mg/L，对应的灵敏度为65.4%，特异度为77.8%。结论 在接受多黏菌素B治疗后，患者血清肌酐及尿素水平升高。AKI发生与多黏菌素B的血药浓度密切相关，临床医师在治疗过程中应进行血药浓度监测，以精准调整用药方案。 |
| 关键词: 多黏菌素B 血药浓度 急性肾损伤 |
| DOI：10.3969/j.issn.1674-3806.2026.01.13 |
| 分类号:R 969 |
| 基金项目: |
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| Analysis on correlation between plasma polymyxin B concentration and risk of acute kidney injury |
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LI Boren1, WEI Ruhua2, CHEN Xiaoyu1, LI Yan1, ZHANG Li1, WEI Shuilin1, TAN Sitao1, GUO Qiuyan1
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1.Department of Pharmacy, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China; 2.Department of Pharmacy, the Fifth Affiliated Hospital of Guangxi Medical University(the First People′s Hospital of Nanning), Nanning 530022, China
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| Abstract: |
| ［Abstract］ Objective To analyze the correlation between plasma polymyxin B concentration and risk of acute kidney injury(AKI). Methods A retrospective analysis was conducted on the clinical data of 53 patients who were hospitalized and treated with polymyxin B in the People′s Hospital of Guangxi Zhuang Autonomous Region from April 1 2024 to August 8, 2024. After 3 doses of polymyxin B were administered for the patients to reach steady state, 2-3 mL of their venous blood was collected 30 minutes before the next dose was administered. A mass spectrometer YS EXACT 9900MD was used to detect plasma polymyxin B concentration. The effect of polymyxin B combined with nephrotoxic antibiotics on the serum creatinine levels of the patients was analyzed. The effect of the use of polymyxin B on the renal function indicators of the patients was analyzed. Multivariate logistic regression was used to analyze the influencing factors for the occurrence of AKI after the administration of polymyxin B. Results Compared with the use of polymyxin B in no combination with nephrotoxic antibiotics, the combination of polymyxin B and nephrotoxic antibiotics did not significantly affect the serum creatinine levels of the patients(P>0.05). Compared with those of the patients before the administration of polymyxin B, the serum creatinine and urea levels of the patients increased, while the creatinine clearance rate decreased after the administration of polymyxin B, and the differences were statistically significant(P<0.05). The results of multivariate logistic regression analysis showed that a higher level of plasma polymyxin B concentration was an independent risk factor for the occurrence of AKI after the administration of polymyxin B［OR(95%CI)=1.874(1.220-2.879), P=0.004］. The results of receiver operating characteristic(ROC) curve analysis showed that plasma polymyxin B concentration could effectively predict the occurrence of AKI ［AUC(95%CI)=0.734(0.599-0.868), P=0.004］, with an optimal cut-off value of 3.18 mg/L, a corresponding sensitivity of 65.4%, and a specificity of 77.8%. Conclusion After receiving polymyxin B treatment, the patients′ serum creatinine and urea levels increase. The occurrence of AKI is closely related to plasma polymyxin B concentration. Clinicians should conduct monitoring of plasma polymyxin B concentration during the treatment process to precisely adjust the medication regimen. |
| Key words: Polymyxin B Plasma drug concentration Acute kidney injury(AKI) |
