Choi Min Hyuk, Choe Yeon Hwa, Lee Sang-Guk, Jeong Seok Hoon, Kim Jeong-Ho
Department of Laboratory Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Clin Chim Acta. 2017 Feb;465:106-111. doi: 10.1016/j.cca.2016.12.021. Epub 2016 Dec 23.
We aimed to identify the impact of the presence of neutropenia on serum vancomycin concentration (SVC).
A retrospective study was conducted from January 2005 to December 2015. The study population was comprised of adult patients who were performed serum concentration of vancomycin. Patients with renal failure or using non-conventional dosages of vancomycin were excluded.
A total of 1307 adult patients were included in this study, of whom 163 (12.4%) were neutropenic. Patients with neutropenia presented significantly lower SVCs than non-neutropenic patients (P<0.0001). Multiple linear regressions showed significant association between neutropenia and trough SVC (beta coefficients, -2.351; P=0.004). Multiple logistic regression analysis also revealed a significant association between sub-therapeutic vancomycin concentrations (trough SVC values<10mg/l) and neutropenia (odds ratio, 1.75, P=0.029) CONCLUSIONS: The presence of neutropenia is significantly associated with low SVC, even after adjusting for other variables. Therefore, neutropenic patients had a higher risk of sub-therapeutic SVC compared with non-neutropenic patients. We recommended that vancomycin therapy should be monitored with TDM-guided optimization of dosage and intervals, especially in neutropenic patients.
我们旨在确定中性粒细胞减少的存在对血清万古霉素浓度（SVC）的影响。
进行了一项从2005年1月至2015年12月的回顾性研究。研究人群包括进行万古霉素血清浓度检测的成年患者。排除了肾衰竭患者或使用非常规剂量万古霉素的患者。
本研究共纳入1307例成年患者，其中163例（12.4%）为中性粒细胞减少患者。中性粒细胞减少患者的SVC显著低于非中性粒细胞减少患者（P<0.0001）。多元线性回归显示中性粒细胞减少与谷浓度SVC之间存在显著关联（β系数，-2.351；P=0.004）。多元逻辑回归分析还显示，治疗不足的万古霉素浓度（谷浓度SVC值<10mg/l）与中性粒细胞减少之间存在显著关联（比值比，1.75，P=0.029）。结论：即使在调整其他变量后，中性粒细胞减少的存在也与低SVC显著相关。因此，与非中性粒细胞减少患者相比，中性粒细胞减少患者发生治疗不足的SVC的风险更高。我们建议，应通过治疗药物监测指导剂量和间隔的优化来监测万古霉素治疗，尤其是在中性粒细胞减少患者中。
