Abstract:

Objective　To explore the clinical efficacies of different daily doses of meropenem in patients with hyperactive renal function. Methods　A retrospective analysis was conducted on 144 patients treated with meropenem at Dongying Second People's Hospital from January 2021 to December 2022. Based on the creatinine clearance rate (CCr), the patients were divided into a hyperactive renal function group (63 cases) and a normal renal function group (81 cases). In the hyperactivity group, there were 37 males and 26 females, aged 37-69 (53.55±4.47) years, with a body mass of 46-93 (71.51±6.06) kg, with a disease course of 1-6 (2.98±0.93) years. In the normal group, there were 48 males and 33 females, aged 41-73 (53.50±4.42) years, with a body weight of 49-89 (71.56±6.01) kg, with a disease course of 1-5 (2.97±0.95) years. The renal function [Ccr, serum creatinine (Scr), and blood urea nitrogen (BUN)], inflammatory indicators [white blood cell count (WBC), neutrophil percentage (NEUT%), procalcitonin (PCT), and C-reactive protein (CRP)], medication status, and clinical efficacy of different daily doses of meropenem were compared between the two groups. Independent sample t test and χ² test were used. Results　The Ccr level in the hyperactivity group was higher than that in the normal group [(126.14±11.63) ml/min vs. (116.25±10.51) ml/min], but the levels of Scr [(47.66±4.25) μmol/L] and BUN [(3.10±0.33) mmol/L] were lower than those in the normal group [(58.62±5.62) μmol/L and (4.22±0.49) mmol/L], with statistically significant differences (all P<0.05). The levels of WBC [(15.55±1.23) ×10⁹/L], NEUT% [(77.85±5.69)%], PCT [(48.60±4.12) µg/L], and CRP [(16.17±3.55) mg/L] in the hyperactivity group were higher than those in the normal group [(9.44±1.56) ×10⁹/L, (68.52±5.52)%, (48.60±4.12) µg/L, and (9.23±1.06) mg/L], with statistically significant differences (all P<0.05). The drug use of the hyperactivity group was higher than that of the normal group at 0.5 g dose (administered every 6 h and every 8 h) and 2.0 g dose (administered every 8 h), but lower than that of the normal group at 1.0 g dose (administered every 8 h and every 12 h), with statistically significant differences (all P<0.05). The clinical effective rates of the hyperactivity group at 1/2 day dose and 2/3 day dose were 0 (0/15 and 0/17), which were lower than those of the normal group [88.89% (8/9) and 92.31% (24/26)], with statistically significant differences (both P<0.05). The clinical effective rate of the hyperactivity group at 1 day dose [50.00% (10/20)] was higher than those at 1/2 day dose and 2/3 day dose, but still lower than that of the normal group [75.61% (31/41)], with statistically significant differences (all P<0.05). The clinical effective rate of the hyperactivity group at double daily dose was 81.82% (9/11), without statistically significant difference compared with 100.00% (5/5) of the normal group (P>0.05). Conclusions　Different doses of meropenem affect the clinical efficacy in patients with hyperactive renal function. The dosage should be ≥ 2.0 g (daily dose), and can be increased to 3.0 g if necessary.

Key words:

Hyperactive renal function, Meropenem, Daily dose, Clinical efficacy

摘要：

目的　探讨不同日剂量美罗培南在肾功能亢进患者中的临床疗效。方法　回顾性分析东营市第二人民医院药学部在2021年1月至2022年12月期间纳入的144例使用美罗培南治疗的患者作为研究对象，按肌酐清除率（Ccr）分为肾功能亢进组（63例）和肾功能正常组（81例）。其中亢进组男性37例，女性26例，年龄37～69（53.55±4.47）岁，体质量46～93（71.51±6.06）kg，病程1～6（2.98±0.93）年；正常组男性48例，女性33例，年龄41～73（53.50±4.42）岁，体质量49～89（71.56±6.01）kg，病程1～5（2.97±0.95）年。比较两组患者肾功能［Ccr、血清肌酐（Scr）、尿素氮（BUN）］、炎症指标［白细胞计数（WBC）、中性粒细胞百分比（NEUT%）、降钙素原（PCT）、C反应蛋白（CRP）］、用药情况及不同日剂量美罗培南的临床疗效。采用独立样本t检验和χ²检验。结果　亢进组Ccr水平（126.14±11.63）ml/min高于正常组（116.25±10.51）ml/min，Scr（47.66±4.25）μmol/L和BUN（3.10±0.33）mmol/L水平均低于正常组（58.62±5.62）μmol/L、（4.22±0.49）mmol/L，差异均有统计学意义（均P<0.05）。亢进组WBC（15.55±1.23）×10⁹/L、NEUT%（77.85±5.69）%、PCT（48.60±4.12）µg/L、CRP（16.17±3.55）mg/L均高于正常组（9.44±1.56）×10⁹/L、（68.52±5.52）%、（48.60±4.12）µg/L、（9.23±1.06）mg/L，差异均有统计学意义（均P<0.05）。亢进组用药情况在0.5 g剂量（每6 h给药1次、每8 h给药1次）、2.0 g剂量（每8 h给药1次）均高于正常组，在1.0 g剂量（每8 h给药1次、每12 h给药1次）均低于正常组，差异均有统计学意义（均P<0.05）。亢进组在1/2日剂量、2/3日剂量的临床有效率均为0（0/15、0/17），均低于正常组的88.89%（8/9）、92.31%（24/26），差异均有统计学意义（均P<0.05）；亢进组1倍日剂量的临床有效率50.00%（10/20）高于本组1/2及2/3日剂量，但仍然低于正常组1倍日剂量75.61%（31/41），差异均有统计学意义（均P<0.05）。亢进组2倍日剂量的临床有效率81.82%（9/11）与正常组100.00%（5/5）比较，差异无统计学意义（P>0.05）。结论　不同日剂量美罗培南影响肾功能亢进患者的临床疗效，用药剂量应≥2.0 g（日剂量），必要时可增加至3.0 g。

关键词:

肾功能亢进, 美罗培南, 日剂量, 临床疗效