Page 111 - 《中国药房》2023年17期

两性霉素B脂质体引起低钾血症的危险因素分析
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符馨尹 ，张纯萍 ，郑秀芬 ，林小茹 ，刘启兵（1.海南医学院第一附属医院药学部，海口 570102；2.文昌市人
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民医院药学部，海南 文昌 571399）
中图分类号 R969.3；R978.5 文献标志码 A 文章编号 1001-0408（2023）17-2149-05
DOI 10.6039/j.issn.1001-0408.2023.17.18

摘 要 目的 探讨两性霉素 B 脂质体引起低钾血症的危险因素，为临床合理用药提供参考。方法 回顾性分析 2012 年 1 月至
2021年12月在海南医学院第一附属医院住院期间使用两性霉素B脂质体的患者信息，收集其两性霉素B脂质体的使用详情和钾
剂补充情况，按照是否发生低钾血症分成低钾血症组和正常组，采用单因素及多因素Logistic回归分析法分析两性霉素B脂质体
引起低钾血症的危险因素。结果 共纳入121例患者，其中低钾血症组60例、正常组61例。低钾血症组患者的两性霉素B脂质体
维持剂量、累积剂量、最大日剂量（重度低钾血症患者）、治疗天数、出现低钾血症的时间、每日补钾剂量（中、重度低钾血症患者）、
总补钾天数（中度低钾血症患者）均显著高于或长于正常组（P＜0.05）。单因素分析结果显示，两性霉素B脂质体累积剂量≥200
mg、治疗天数≥5 d对该药引起低钾血症有显著影响（P＜0.05）。多因素分析结果显示，患者存在基础低血钾、体重＜50 kg、两性
霉素B脂质体累积剂量≥200 mg、治疗天数≥5 d是该药引起低钾血症的独立危险因素（P＜0.05）。结论 两性霉素B脂质体引起
低血钾症的发生率较高，其引起低钾血症的独立危险因素为累积剂量≥200 mg、治疗天数≥5 d、患者存在基础低血钾及体重＜50
kg。建议在应用该药治疗前将患者血清钾补充至正常水平，给药期间密切监测血清钾变化，以减少低钾血症的发生。
关键词 两性霉素B脂质体；低钾血症；危险因素

Analysis of risk factors for hypokalemia caused by amphotericin B liposome
FU Xinyin ，ZHANG Chunping ，ZHENG Xiufen ，LIN Xiaoru ，LIU Qibing（1. Dept. of Pharmacy， the First
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Affiliated Hospital of Hainan Medical University， Haikou 570102， China；2. Dept. of Pharmacy， Wenchang
Municipal People’s Hospital， Hainan Wenchang 571399， China）
ABSTRACT OBJECTIVE To investigate the risk factors for hypokalemia caused by amphotericin B liposome， and to provide
reference for clinical use of drugs. METHODS A retrospective analysis was used to collect the information of patients who used
amphotericin B liposome during the hospitalization in First Affiliated Hospital of Hainan Medical College from January 2012 to
December 2021. The details of use information about amphotericin B liposome and the potassium supplementation were collected.
The patients were divided into hypokalemia group and normal group according to the occurrence of hypokalemia. Univariate and
multi-variate Logistic regression analyses were used to analyze the risk factors for hypokalemia induced by amphotericin B
liposome. RESULTS Of the 121 patients included in this analysis， 60 patients were in hypokalemia group， 61 patients were in
normal group. The following parameters of the hypokalemic group were significantly higher or longer than those of the normal
group， such as the maintenance dose， cumulative dose and maximum daily dose （in patients with severe hypokalemia） of
amphotericin B liposome， treatment days， the maintained days of hypokalemia， daily dose of potassium supplement （in patients
with moderate or severe hypokalemia）， the duration of potassium supplement （in patients with moderate hypokalemia）. Results of
single factor analysis showed that the cumulative dose of amphotericin B liposome ≥200 mg and the duration of treatment ≥5 days
were independent risk factors of hypokalemia caused by this drug （P＜0.05）. Multi-variate analysis results showed that the presence
of basic hypokalemia， body weight ＜50 kg， cumulative dose of amphotericin B liposome ≥200 mg and the duration of
treatment ≥5 days were the independent risk factors for hypokalemia caused by amphotericin B liposome （P＜0.05）.
CONCLUSIONS The incidence of hypokalemia caused by amphotericin B liposome is high， the independent risk factors for
hypokalemia include cumulative dose ≥200 mg， treatment days ≥5 days， the presence of basic hypokalemia and body weight ＜
50 kg. It is suggested that serum potassium should be elevated to normal level before amphotericin B liposome treatment， and the
level of serum potassium should be monitored during medication to reduce the occurrence of hypokalemia.
KEYWORDS amphotericin B liposome； hypokalemia； risk factors

两性霉素B属于多烯类抗真菌药物，通过作用于真
菌细胞膜的麦角固醇，引起细胞膜通透性改变，使细胞
Δ 基金项目 海南省自然科学基金青年基金项目（No.819QN368）
＊第一作者 主管药师，硕士。研究方向：临床药学。电话：0898- 内钾离子、核苷酸和氨基酸等物质外漏，最终导致真菌
66517965。E-mail：fxy08531@126.com 细胞死亡，具有疗效稳定、不易诱导真菌耐药、抗菌谱广

中国药房 2023年第34卷第17期 China Pharmacy 2023 Vol. 34 No. 17 · 2149 ·