Ambinder R F, Moore R D, Smith C R, Mellits E D, Lietman P S
Antimicrob Agents Chemother. 1985 Feb;27(2):217-9. doi: 10.1128/AAC.27.2.217.
We sought to determine whether there was an interaction between aminoglycoside use and shock in their effect on renal function among seriously ill patients suspected of having gram-negative sepsis. Serial serum creatinine determinations were used to estimate changes in creatinine clearance rates in 179 patients entered onto a prospective randomized trial of tobramycin-nafcillin versus cefotaxime. A 25% decline in estimated creatinine clearance was considered to be clinically important. Univariate chi-square analysis showed that both shock (P less than 0.01) and tobramycin use (P less than 0.001) were independently associated with decline in estimated creatinine clearance. A two-way analysis of variance showed that both shock (F = 10.44, P less than 0.01) and tobramycin use (F = 42.6, P less than 0.001) continued to be significantly associated with renal dysfunction in the presence of each other, but there was no significant interaction between shock and tobramycin in their effect (F = 0.62, P less than 0.43). A multiple logistic regression with an interaction term representing the occurrence of shock and tobramycin use simultaneously yielded similar results. Our study provided no analytic evidence supporting the existence of an interaction between shock and aminoglycoside use in their effect on renal function.
我们试图确定在怀疑患有革兰氏阴性菌败血症的重症患者中，氨基糖苷类药物的使用与休克对肾功能的影响之间是否存在相互作用。在一项关于妥布霉素-萘夫西林与头孢噻肟的前瞻性随机试验中，对179例患者进行了连续血清肌酐测定，以评估肌酐清除率的变化。估计肌酐清除率下降25%被认为具有临床意义。单因素卡方分析显示，休克（P<0.01）和妥布霉素的使用（P<0.001）均与估计肌酐清除率下降独立相关。双向方差分析显示，休克（F = 10.44，P<0.01）和妥布霉素的使用（F = 42.6，P<0.001）在彼此存在的情况下仍与肾功能不全显著相关，但休克和妥布霉素在其影响方面没有显著的相互作用（F = 0.62，P<0.43）。一项包含代表休克和妥布霉素同时使用情况的交互项的多元逻辑回归得出了类似的结果。我们的研究没有提供分析证据支持休克与氨基糖苷类药物使用在对肾功能的影响方面存在相互作用。
