Page 79 - 《中国药房》2025年9期

·药物与临床·

儿童患者万古霉素稳态血药浓度谷值与AUC /MIC的相关性及
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治疗失败的危险因素分析
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林金香 ，王幼鸿，肖智锋，王 晶，宋 颖，蔡凝芳，吴秀萍（厦门市儿童医院/复旦大学附属儿科医院厦门医院
＊
药学部，福建 厦门 361006）

中图分类号 R969 文献标志码 A 文章编号 1001-0408（2025）09-1093-06
DOI 10.6039/j.issn.1001-0408.2025.09.13

摘 要 目的 评估儿童患者万古霉素稳态血药浓度谷值（cmin ）与24 h药时曲线下面积（AUC24 ）/最小抑菌浓度（MIC）比值（AUC24/
MIC）的相关性，并分析万古霉素治疗失败的独立危险因素。方法 回顾性收集2021年1月至2024年7月于我院使用万古霉素治
疗且进行治疗药物监测的住院患儿资料，按治疗是否成功分为成功组和失败组。采用Spearman相关性分析评估万古霉素cmin与
AUC24/MIC的相关性，采用单因素及多因素Logistic回归分析筛选万古霉素治疗失败的独立危险因素。结果 共纳入59例患儿，
成功组41例、失败组18例。与失败组比较，成功组患儿的万古霉素AUC24/MIC显著升高（P＝0.038）；但两组患儿的cmin比较，差异
无统计学意义（P＞0.05）。万古霉素的cmin与AUC24/MIC呈显著正相关（r＝0.499，P＜0.001），但其对AUC24/MIC达标（≥400）有一
定的预测效能（受试者操作特征曲线下面积＝0.696），Youden指数确定的最佳截断值为6.05 mg/L。AUC24/MIC预测治疗失败的效
能优于 cmin （受试者操作特征曲线下面积为 0.671 vs. 0.523，P 为 0.038 vs. 0.684），敏感性更高（83.3% vs. 66.7%）。低蛋白血症和
AUC24/MIC≤369.1是导致万古霉素治疗失败的独立危险因素（P＜0.05）。患儿肾毒性发生率为3.4%。结论 儿童患者万古霉素
的cmin与AUC24/MIC呈显著正相关；低蛋白血症和AUC24/MIC≤369.1是导致患儿万古霉素治疗失败的独立危险因素。
关键词 万古霉素；稳态血药浓度谷值；24 h药时曲线下面积；最小抑菌浓度；相关性；危险因素

Correlation of the steady-state minimal concentration with AUC24/MIC of vancomycin and analysis of risk
factors for treatment failure in pediatric patients
LIN Jinxiang，WANG Youhong，XIAO Zhifeng，WANG Jing，SONG Ying，CAI Ningfang，WU Xiuping（Dept. of
Pharmacy， Xiamen Children’s Hospital/Children’s Hospital of Fudan University at Xiamen， Fujian Xiamen
361006， China）

ABSTRACT OBJECTIVE To assess the correlation between the steady-state minimal concentration （cmin ） and 24 h area under
the drug concentration-time curve （AUC24 ）/minimal inhibitory concentration （MIC） ratio （AUC24/MIC） of vancomycin in pediatric
patients， and analyze independent risk factors for treatment failure. METHODS Data of hospitalized children treated with
vancomycin and receiving therapeutic drug monitoring in our hospital from January 2021 to July 2024 were retrospectively collected
and divided into success group and failure group according to whether the treatment was successful or not. Spearman correlation
analysis was used to analyze the correlation between cmin and AUC24/MIC of vancomycin， and one-way and multifactorial Logistic
regression analyses were used to screen the independent risk factors for vancomycin treatment failure. RESULTS A total of 59
children were included， with 41 in the success group and 18 in the failure group. Compared with the failure group， AUC24/MIC of
vancomycin was significantly higher in the success group （P＝0.038）， but there was no statistically significant difference in the cmin
of the two groups （P＞0.05）； cmin of vancomycin was significantly positively correlated with AUC24/MIC （r＝0.499， P＜0.001），
but it has a certain efficacy in predicting the achievement of the AUC24/MIC standard （≥400） （area under the receiver operator
characteristic curve＝0.696）， with an optimal cutoff value of 6.05 mg/L determined by the Youden index. The efficacy of AUC24/
MIC in predicting treatment failure was superior to cmin （areas
Δ 基金项目 国家自然科学基金-青年科学基金项目（No.82204535）； under the receiver operator characteristic curve were 0.671 vs.
厦门市科技计划项目（No.3502Z20227145，No.3502Z202372098）；厦门
0.523， P were 0.038 vs. 0.684）， with higher sensitivity
市医疗卫生指导性项目（No.3502Z20224ZD1269） （83.3% vs. 66.7%）. Hypoproteinemia and AUC24/MIC≤369.1
＊第一作者 主管药师，硕士。研究方向：医院药学、临床药学。
were independent risk factors for vancomycin treatment failure
E-mail：291320157@qq.com
# 通信作者 主任药师。研究方向：医院药学、药事管理。E-mail： （P＜0.05）. The incidence of nephrotoxicity was 3.4%.
hlyyyxk@126.com CONCLUSIONS There is a significant positive correlation

中国药房 2025年第36卷第9期 China Pharmacy 2025 Vol. 36 No. 9 · 1093 ·