中国临床药理学杂志2025，Vol.41Issue(16)：2281-2286,6.DOI:10.13699/j.cnki.1001-6821.2025.16.006
美罗培南治疗药物监测在重症感染合并肾功能亢进患者的临床研究
Clinical study of meropenem therapeutic drug monitoring in patients with severe infection complicated with augmented renal clearance
朱珍真 1谢英 1杜凤霞 1郎丽巍 1李倩玉 1张静 1王芳1
作者信息
- 1. 解放军总医院医疗保障中心药剂科,北京 100039
- 折叠
摘要
Abstract
Objective To investigate the influence of augmented renal clearance(ARC)on the steady-state serum concentration and pharmacodynamics of meropenem in patients with severe infections and to analyze the linear relationship between them.Methods A retrospective analysis was conducted on the inpatients who received meropenem treatment and underwent therapeutic drug monitoring(TDM)at the Fifth Medical Center of the General Hospital of the PLA from June 2021 to September 2024.Serum drug concentration data were collected,and pharmacokinetic parameters were calculated using a one-compartment model.The steady-state serum concentrations and pharmacodynamic parameters were compared between patients with normal renal function and those with ARC.Multiple linear regression analysis was performed to explore the factors influencing meropenem serum concentrations and pharmacodynamic parameters.Results When meropenem was administered at a dose of 1.0 g three times daily,the blood concentrations in patients with ARC at 3 hours and 0.5 hours before the last administration were(4.78±2.34)mg·L-1 and(2.44±1.60)mg·L-1,respectively.In contrast,the corresponding concentrations in patients with normal renal function were(14.08±10.45)mg·L-1 and(8.40±7.07)mg·L-1,respectively.The blood concentrations of meropenem were significantly lower in ARC patients compared to those with normal renal function(P＜0.05).For the pharmacodynamic target of f％T＞4MIC 40％,the target attainment rates in ARC patients were 81.25％,25.00％,0.00％,and 0.00％at MIC values of 1,2,4,and 8 μg·mL-1,respectively.In comparison,the rates in patients with normal renal function were 92.31％,76.92％,53.85％,and 7.69％,respectively,indicating significantly lower target attainment in the ARC group.Multiple linear regression analysis revealed that creatinine clearance rate and serum albumin level significantly influenced both the plasma concentration and pharmacodynamic target attainment of meropenem.Conclusion ARC significantly reduces the steady-state serum concentration of meropenem and the rate of achieving pharmacodynamic targets,leading to the failure of anti-infective therapy.For patients with severe infections and ARC,attention should be paid to the effects of creatinine clearance,serum albumin on serum drug concentrations and therapeutic efficacy.TDM should be performed to adjust the dosing regimen in a timely manner.关键词
美罗培南/肾功能亢进/血药浓度/药效学/治疗药物监测/多重线性回归Key words
meropenem/augmented renal clearance/plasma drug concentration/pharmacodynamics/therapeutic drug monitoring/multiple linear regression分类
医药卫生引用本文复制引用
朱珍真,谢英,杜凤霞,郎丽巍,李倩玉,张静,王芳..美罗培南治疗药物监测在重症感染合并肾功能亢进患者的临床研究[J].中国临床药理学杂志,2025,41(16):2281-2286,6.
