【作者】 侯雅琴； 封永莉； 欧亚青； 张晓勤； 陈璐；

【Author】 Hou Yaqin;Feng Yongli;Ou Yaqing;Zhang Xiaoqin;Chen Lu;School of Medince of UESTC;Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital;

【机构】 电子科技大学医学院； 电子科技大学附属医院·四川省人民医院；

【摘要】 目的:通过监测感染G+患者替考拉宁稳态血药浓度,收集整理其基本信息与生化检测数据,统计分析,探讨与替考拉宁血药浓度相关因素。方法:建立HPLC法监测替考拉宁稳态血药浓度。采用spss20.0统计软件进行分析,计量资料以x±s表示,2组间比较采用t检验,计数资料采用χ~2检验,并进行spearman相关性分析,以p<0.05为差异有统计学意义。结果:2017年9月至2018年7月监测样本61例/次,共39例患者。血药浓度范围为:2.696-48.58 ug/mL;平均血药浓度14.90±10.19ug/mL。其中<10ug/mL 26例/次占42.62%;10-30ug/mL 27例/次占44.26%;>30ug/ml 8例/次占13.11%。以欧洲说明书谷浓度范围10—30ug/mL为标准,39例患者替考拉宁血药浓度不达标率占55.74%。统计分析发现血药浓度无性别差异(p=0.126)。将患者分为青年组(<45岁),中年组(45岁-60岁),老年组(>60岁),青年组与老年组的血药浓度有显著性差异(p=0.003),老年组浓度明显偏高。血药浓度与中性粒细胞率(p=0.026,r=0.420)、白蛋白(p=0.044,r=0.383)、总蛋白(p=0.049,r=0.376)、尿素(p=0.000,r=0.615)尿酸(p=0.004,r=0.533)、肌酐(p=0.013,r=0.463)成正相关;与体重(p=0.033,r=-0.457)、估算肾小球滤过率(p=0.003,r=-0.544)成负相关。讨论:替考拉宁血药浓度个体差异大,不达标率高,需通过TDM进行调整。1.既往文献表明替考拉宁血浆蛋白结合率为90%-95%,血浆蛋白含量对血药浓度影响较大。另替考拉宁在体内大部分以原形经肾脏排出,肾功能强弱与其浓度直接相关。本研究通过统计与分析患者相关临床数据,其分析结果与文献结果一致。更进一步明确了替考拉宁血药浓度与患者白蛋白、总蛋白、尿素、尿素、肌酐成正相关,和估算肾小球滤过率(负相关),有利于药物个体化用药方案制定。2.患者血药浓度与中性粒细胞率成正相关,可能由于中性粒细胞与细胞的吞噬和消化功能有关,可反应机体的感染程度,表明感染层度可能会影响血药浓度。3.患者年龄和体重与其血药浓度相关,与个别文献报道相悖,可能为患者群体年龄偏高及分析方法差异所致,有待进一步研究。更多还原

【Abstract】 OBJECTIVE: To monitor the steady-state plasma concentration of teicoplanin in patients with Gram-positive bacteria infection, collect and analyze the basic information and biochemical test data, and analyze the statistical analysis to explore the factors related to the blood concentration of teicoplanin.METHODS: HPLC method was established to monitor the steady-state plasma concentration of teicoplanin. Spss20.0 using statistical software to analyze measurement datax±s expressed between the two groups were compared using t test,count data using the χ2 test and Spearman correlation analysis, at p<0.05 was considered statistically significant.RESULTS: September 2017 to July 2018 monitoring samples 61 cases/times, a total of 39 patients. The plasma concentration ranged from 2.696 to 48.58 ug/mL; the mean plasma concentration was 14.90±10.19 ug/mL. Among them, <10 ug/mL 26 cases/time accounted for 42.62%; 10-30 ug/mL 27 cases/time accounted for 44.26%; >30 ug/ml 8 cases/time accounted for 13.11%. European specification range trough concentration10-30 ug/mL standard, the patient serum concentration of teicoplanin 39 cases of non-compliance rate of the 55.74%.Statistical analysis revealed no gender difference in blood drug concentration(p=0.126). The patients were divided into a young group(<45 years old), a middle-aged group(45-60 years old), and an elderly group(>60 years old). There was a significant difference in blood concentration between the young group and the elderly group(p=0.003). The concentration in the elderly group was significantly higher. Plasma concentration and neutrophil rate(p=0.026, r=0.420),albumin(p=0.044, r=0.383), total protein(p=0.049, r=0.376), urea(p=0.000, r=0.615) uric acid(p=0.004, r=0.533), creatinine(p=0.013, r=0.463) was positively correlated; with body weight(p=0.033, r=-0.457), estimated glomerular filtration rate(p= 0.003, r =-0.544) is negatively correlated.DISCUSSION:The blood concentration of teicoplanin is large, and the rate of non-compliance is high. It needs to be adjusted by TDM. 1. Previous literature indicates that the plasma protein binding rate of teicoplanin is 90%-95%, and the plasma protein content has a great influence on the plasma concentration. In addition, most of the caroline is excreted in the body by the kidney, and the strength of the kidney is directly related to its concentration. This study used statistical and analytical patient-related clinical data, and the results were consistent with the literature results. It is further clarified that the blood concentration of teicoplanin is positively correlated with albumin, total protein, urea, urea and creatinine, and the glomerular filtration rate(negative correlation) is estimated,which is conducive to the formulation of drug individualized medication. 2. The blood concentration of the patient is positively correlated with the neutrophil rate. It may be related to the phagocytosis and digestive function of the neutrophils,which may reflect the degree of infection of the organism, indicating that the infection layer may affect the blood concentration. 3. The age and weight of the patients are related to their blood concentration, which is contrary to the individual literature reports. It may be due to the high age of the patient group and the difference in analytical methods, which needs further study.更多还原