腹膜透析相关性腹膜炎患者的万古霉素首次血药浓度影响因素分析

doi:10.12092/j.issn.1009-2501.2026.09.008

中国临床药理学与治疗学 ›› 2026, Vol. 31 ›› Issue (9): 1221-1230.doi: 10.12092/j.issn.1009-2501.2026.09.008

• 临床药理学 • 上一篇

腹膜透析相关性腹膜炎患者的万古霉素首次血药浓度影响因素分析

姜俞濛¹(), 李建中¹, 杭永付², 杨友静³, 陶莎莎³, 胡坤¹, 徐德宇¹, 卢国元¹^,*()

1. 苏州大学附属第一医院肾内科，苏州 215006，江苏
2. 苏州大学附属第一医院药剂科，苏州 215006，江苏
3. 重庆市急救医疗中心急诊医学重庆市重点实验室，重庆 400014

收稿日期:2025-07-04 修回日期:2025-12-15 出版日期:2026-09-26 发布日期:2026-10-08
通讯作者: 卢国元 E-mail:18151820813@163.com;sdfyylgy@163.com
作者简介:姜俞濛，女，硕士研究生，住院医师，研究方向：血药浓度影响因素。E-mail：18151820813@163.com
基金资助:
江苏省自然科学基金面上项目（BK20231199）；苏州市医疗卫生创新项目（SKY2022141）；急诊医学重庆市重点实验室开放课题（2023KFKT07）；重庆市教委科学技术研究项目（KJQN202300104，KJZD-K202300102）

Influencing factors of the first serum concentration of vancomycin in patients with peritoneal dialysis-related peritonitis

Yumeng JIANG¹(), Jianzhong LI¹, Yongfu HANG², Youjing YANG³, Shasha TAO³, Kun HU¹, Deyu XU¹, Guoyuan LU¹^,*()

1. Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
2. Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, China
3. Chongqing Emergency Medical Center Chongqing Key Laboratory of Emergency Medicine, Chongqing 400014, China

Received:2025-07-04 Revised:2025-12-15 Online:2026-09-26 Published:2026-10-08
Contact: Guoyuan LU E-mail:18151820813@163.com;sdfyylgy@163.com

摘要/Abstract

摘要：

目的: 分析腹膜透析相关性腹膜炎（peritoneal dialysis-related peritonitis，PDRP）患者腹腔内注射万古霉素后血药浓度的影响因素及与临床疗效的相关性。方法: 回顾性收集2021年1月至2024年8月苏州大学附属第一医院37例接受腹腔1 g万古霉素给药并监测血药浓度的PDRP患者临床资料，于第2次给药前0.5 h采血，测定首次血药浓度（谷浓度）。结果: 17例既往有腹膜炎感染史的PDRP患者首次血药浓度为11.22（9.46，11.93）μg/mL，显著高于20例无感染史的PDRP患者首次血药浓度[8.66（7.84，9.51）μg/mL（P<0.01）]；Logistic回归分析提示腹膜炎感染史及给药间隔时长是首次血药浓度的独立影响因素（P<0.01）；腹膜炎感染史在任何给药间隔下均能提高浓度，而给药间隔时间仅在无感染史患者中起明显作用；万古霉素治疗前、后，腹透液细胞成分及转阴天数在高浓度组与低浓度组差异无统计学意义（P>0.05）；两组治疗后腹透液细胞成分和C反应蛋白（C-reactive protein，CRP）水平均较治疗前下降（P<0.05）；高浓度组患者治疗后CRP水平较低浓度组患者高（P<0.05）。结论: 既往腹膜炎感染史和给药间隔时长可显著影响万古霉素首次血药浓度，但首次浓度水平对PDRP患者的临床疗效和转阴天数无显著影响。

关键词: 腹透相关性腹膜炎, 万古霉素, 血药浓度, 影响因素

Abstract:

AIM: To investigate the factors influencing the first serum concentration of vancomycin and its relationship to clinical efficacy in patients with peritoneal dialysis-related peritonitis (PDRP) receiving intraperitoneal administration. METHODS: We collected clinical data from 37 PDRP patients treated at The First Affiliated Hospital Of Soochow University between January 2021 and August 2024. All patients received 1 g intraperitoneal vancomycin and underwent serum concentration monitoring. Blood samples were drawn 0.5 h before the second dose to determine the first serum concentration. RESULTS: Seventeen patients with a prior history of peritonitis had a significantly higher first serum concentration [11.22(9.46,11.93) μg/mL] than 20 patients without such history [8.66(7.84,9.51) μg/mL; P<0.01]. Logistic regression identified that both prior peritonitis history and dosing interval duration were independent factors affecting the first serum concentration (P<0.01). A history of peritonitis elevates the first serum concentration at any dosing interval, whereas dosing interval significantly impacts concentrations only in patients without such a history. Before and after vancomycin treatment, there was no significant difference between the high-concentration group and the low-concentration group in the cell components of peritoneal fluid or time to negative culture conversion (P>0.05). Both groups showed significant reductions in the cell components of peritoneal fluid and C-reactive protein (CRP) levels post-treatment compared to baseline (P<0.05). Post-treatment CRP levels were significantly lower in the low-concentration group than in the high-concentration group (P<0.05). CONCLUSION: A history of prior peritonitis and the length of the dosing interval significantly affect the first serum concentration of intraperitoneal vancomycin in PDRP patients; However, the absolute first serum concentration level does not appear to influence clinical efficacy or time to culture negativity.

Key words: peritoneal dialysis-related peritonitis, vancomycin, serum concentration, influential factor

中图分类号:

姜俞濛, 李建中, 杭永付, 杨友静, 陶莎莎, 胡坤, 徐德宇, 卢国元. 腹膜透析相关性腹膜炎患者的万古霉素首次血药浓度影响因素分析[J]. 中国临床药理学与治疗学, 2026, 31(9): 1221-1230.

Yumeng JIANG, Jianzhong LI, Yongfu HANG, Youjing YANG, Shasha TAO, Kun HU, Deyu XU, Guoyuan LU. Influencing factors of the first serum concentration of vancomycin in patients with peritoneal dialysis-related peritonitis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2026, 31(9): 1221-1230.

图/表 10

参考文献 24

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Baseline characteristics	Dosing interval 48 h group	Dosing interval 72 h group	P
Dialysis duration (month)	38(19,47)	34(20,98)	0.673
Scr (μmol/L)	1184.10(628.50,1382.05)	946.45(783.80,1134.68)	0.126
CysC (mg/L)	7.12(5.73,8.16)	7.07(5.57,8.17)	0.933
Urea (mmol/L)	24.00(14.85,26.30)	22.40(16.90,29.20)	0.768
UA (μmol/L)	351.00(274.80,464.00)	327.60(279.28,401.13)	0.399
Urine volume (mL/24 h)	0(0,865)	0(0,125)	0.418
Kt/V	1.56(1.44,1.73)	1.68(1.37,1.88)	0.593
D/P	0.68(0.62,0.75)	0.69(0.61,0.75)	0.994
Peritoneal dialysate nucleated cell count (10⁹/L)	1.056(0.423,5.366)	1.562(0.396,4.712)	0.978
Percentage of neutrophils in dialysate (%)	86.0(79.4,90.3)	83.7(74.4,90.1)	0.663
Peripheral blood WBC count (10⁹/L)	7.20(4.57,9.22)	6.84(5.08,8.72)	0.966
Peripheral blood neutrophil percentage (%)	75.4(68.4,83.8)	78.2(67.0,83.5)	0.536
CRP (mg/L)	12.93(10.06,50.34)	27.38(14.25,49.55)	0.126
History of peritonitis infection (%)			0.699
No	7(50.00)	13(56.52)
Yes	7(50.00)	10(43.48)

Baseline characteristics	Dosing interval 48 h group	Dosing interval 72 h group	P
Dialysis duration (month)	38(19,47)	34(20,98)	0.673
Scr (μmol/L)	1184.10(628.50,1382.05)	946.45(783.80,1134.68)	0.126
CysC (mg/L)	7.12(5.73,8.16)	7.07(5.57,8.17)	0.933
Urea (mmol/L)	24.00(14.85,26.30)	22.40(16.90,29.20)	0.768
UA (μmol/L)	351.00(274.80,464.00)	327.60(279.28,401.13)	0.399
Urine volume (mL/24 h)	0(0,865)	0(0,125)	0.418
Kt/V	1.56(1.44,1.73)	1.68(1.37,1.88)	0.593
D/P	0.68(0.62,0.75)	0.69(0.61,0.75)	0.994
Peritoneal dialysate nucleated cell count (10⁹/L)	1.056(0.423,5.366)	1.562(0.396,4.712)	0.978
Percentage of neutrophils in dialysate (%)	86.0(79.4,90.3)	83.7(74.4,90.1)	0.663
Peripheral blood WBC count (10⁹/L)	7.20(4.57,9.22)	6.84(5.08,8.72)	0.966
Peripheral blood neutrophil percentage (%)	75.4(68.4,83.8)	78.2(67.0,83.5)	0.536
CRP (mg/L)	12.93(10.06,50.34)	27.38(14.25,49.55)	0.126
History of peritonitis infection (%)			0.699
No	7(50.00)	13(56.52)
Yes	7(50.00)	10(43.48)

Variable	Low-serum concentration group	High-serum concentration group	P
Sex (%)			0.742
Male	12(57.14)	10(62.50)
Female	9(42.86)	6(37.50)
Age (years)	46(37,63)	48(37,65)	0.978
BSA (m²)	1.80(1.70,1.96)	1.84(1.56,1.94)	0.391
Dialysis duration (month)	38(19,61)	34(22,94)	0.649
eGFR [mL/(min·1.73 m²)]	5.00(4.05,5.60)	4.40(3.60,6.10)	0.934
Scr (μmol/L)	955.20(829.43,1170.90)	1057.10(573.50,1372.50)	0.772
CysC (mg/L)	7.27(5.37,8.22)	7.12(6.27,7.44)	0.610
Urea (mmol/L)	23.40(18.20,26.10)	20.80(11.80,30.20)	0.363
UA (μmol/L)	373.15(309.15,416.43)	291.70(274.20,394.25)	0.080
ALT (U/L)	12.70(9.43,19.00)	8.50(6.80,15.20)	0.045^*
AST (U/L)	12.20(10.30,17.20)	11.50(9.20,20.40)	0.895
Urine volume (mL/24 h)	0(0,200)	0(0,365)	0.678
Kt/V	1.62(1.40,1.88)	1.57(1.34,1.73)	0.581
D/P	0.70(0.61,0.76)	0.68(0.60,0.73)	0.349
Peritoneal dialysate nucleated cell count (10⁹/L)	0.882(0.313,4.832)	1.182(0.574,5.286)	0.355
Percentage of neutrophils in dialysate (%)	85.0(75.0,92.0)	86.0(76.4,88.4)	0.783
Peripheral blood WBC count (10⁹/L)	6.49(5.15,9.22)	7.20(4.46,8.81)	0.501
Peripheral blood neutrophil percentage (%)	79.8(68.2,83.8)	73.1(63.6,82.5)	0.214
CRP (mg/L)	26.16(12.08,85.2)	15.68(12.45,43.80)	0.155
Bacterial species (%)			0.500
G⁺	11(52.38)	11(68.75)
G^?	10(47.62)	5(31.25)
Dosing interval (h)			0.015^*
48	4(19.05)	10(62.50)
72	17(80.95)	6(37.50)
History of peritonitis (%)			0.022^*
No	15(71.43)	5(31.25)
Yes	6(28.57)	11(68.75)

Variable	Low-serum concentration group	High-serum concentration group	P
Sex (%)			0.742
Male	12(57.14)	10(62.50)
Female	9(42.86)	6(37.50)
Age (years)	46(37,63)	48(37,65)	0.978
BSA (m²)	1.80(1.70,1.96)	1.84(1.56,1.94)	0.391
Dialysis duration (month)	38(19,61)	34(22,94)	0.649
eGFR [mL/(min·1.73 m²)]	5.00(4.05,5.60)	4.40(3.60,6.10)	0.934
Scr (μmol/L)	955.20(829.43,1170.90)	1057.10(573.50,1372.50)	0.772
CysC (mg/L)	7.27(5.37,8.22)	7.12(6.27,7.44)	0.610
Urea (mmol/L)	23.40(18.20,26.10)	20.80(11.80,30.20)	0.363
UA (μmol/L)	373.15(309.15,416.43)	291.70(274.20,394.25)	0.080
ALT (U/L)	12.70(9.43,19.00)	8.50(6.80,15.20)	0.045^*
AST (U/L)	12.20(10.30,17.20)	11.50(9.20,20.40)	0.895
Urine volume (mL/24 h)	0(0,200)	0(0,365)	0.678
Kt/V	1.62(1.40,1.88)	1.57(1.34,1.73)	0.581
D/P	0.70(0.61,0.76)	0.68(0.60,0.73)	0.349
Peritoneal dialysate nucleated cell count (10⁹/L)	0.882(0.313,4.832)	1.182(0.574,5.286)	0.355
Percentage of neutrophils in dialysate (%)	85.0(75.0,92.0)	86.0(76.4,88.4)	0.783
Peripheral blood WBC count (10⁹/L)	6.49(5.15,9.22)	7.20(4.46,8.81)	0.501
Peripheral blood neutrophil percentage (%)	79.8(68.2,83.8)	73.1(63.6,82.5)	0.214
CRP (mg/L)	26.16(12.08,85.2)	15.68(12.45,43.80)	0.155
Bacterial species (%)			0.500
G⁺	11(52.38)	11(68.75)
G^?	10(47.62)	5(31.25)
Dosing interval (h)			0.015^*
48	4(19.05)	10(62.50)
72	17(80.95)	6(37.50)
History of peritonitis (%)			0.022^*
No	15(71.43)	5(31.25)
Yes	6(28.57)	11(68.75)

Variable	Univariate logistic		Multivariate logistic
Variable	OR(95%CI)	P	OR(95%CI)	P
Sex (%)
Male	Reference
Female	1.006(0.296,3.422)	0.992
Age (years)	0.999(0.963,1.036)	0.966
BSA (m²)	0.290(0.016,5.194)	0.400
Dialysis duration (month)	1.003(0.992,1.015)	0.597
Scr (μmol/L)	1.117(0.677,1.842)	0.666
CysC (mg/L)	0.943(0.658,1.352)	0.749
Urea (mmol/L)	0.977(0.921,1.036)	0.440
UA (μmol/L)	0.996(0.990,1.001)	0.114
ALT (U/L)	0.961(0.907,1.019)	0.183
AST (U/L)	1.043(0.980,1.110)	0.183
Urine volume (mL/24 h)	1.146(0.695,1.891)	0.593
Kt/V	0.869(0.296,2.546)	0.798
D/P	0.081(0.000,14.740)	0.344
Peritoneal dialysate nucleated cell count (10⁹/L)	0.959(0.834,1.102)	0.552
Percentage of neutrophils in dialysate (%)	0.989(0.947,1.032)	0.604
Peripheral blood WBC count (10⁹/L)	1.059(0.907,1.237)	0.470
Peripheral blood neutrophil percentage (%)	0.973(0.927,1.021)	0.266
CRP (mg/L)	0.986(0.972,1.001)	0.066	0.986(0.969,1.004)	0.138
Bacterial species (%)
G⁺	Reference
G^?	0.450(0.160,1.267)	0.130
Dosing interval (h)
48	Reference
72	0.158(0.052,0.485)	0.001	0.092(0.021,0.400)	0.001
History of peritonitis (%)
No	Reference
Yes	2.719(1.551,4.767)	0.000	3.207(1.568,6.560)	0.001

腹膜透析相关性腹膜炎患者的万古霉素首次血药浓度影响因素分析

Influencing factors of the first serum concentration of vancomycin in patients with peritoneal dialysis-related peritonitis

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Variable	Unstandardized coefficients		Standardized coefficients	T	P	Collinearity diagnostics
Variable	B	Standard error	Beta	T	P	VIF
CRP	?0.002	0.001	?0.194	?1.881	0.065	1.039
Dosing interval	?0.408	0.103	?0.400	?3.954	<0.001	1.007
History of peritonitis	0.383	0.103	0.393	3.815	<0.001	1.044
R²	0.399
Adjusted R²	0.369

Group	Peritoneal dialysate nucleated cell count (10⁹/L)		P	Percentage of neutrophils in dialysate (%)		P	Days to negative conversion (d)
Group	Before treatment	After treatment	P	Before treatment	After treatment	P	Days to negative conversion (d)
Low-serum concentration group (n=11)	0.396(0.226,6.238)	0.020(0.007,0.026)	<0.001	80.7(75.0,90.9)	10.0(6.4,22.7)	<0.001	5(2,8)
High-serum concentration group (n=11)	1.182(0.574,6.285)	0.011(0.004,0.43)	<0.001	86.4(78.0,87.2)	9.3(0.0,18.0)	<0.001	5(3,7)
P	0.158	0.641		0.821	0.373		0.798

Author (Year)	Country	Case number	Dosage regimen	Serum concentration target	Main conclusions
Xie Jing et al.(2024)^[5]	China	40	0.5 g vancomycin, administered qd, qod and q2d; Adjusting dosing regimens based on the serum concentration.	15 μg/mL (ISPD guideline)	First serum concentration is difficult to achieve target; Clinical efficacy correlates with concentrations ≥10 μg/mL but not with 15 μg/mL.
Cai Le et al.(2021)^[8]	China	24	1 g vancomycin, administered qd, qod and q2d.	15 μg/mL (ISPD guideline)	First serum concentration is difficult to achieve target.
Hang Yong Fu et al.(2019)^[6]	China	41	1 g vancomycin, administered q3d, q4d and q5d.	15 μg/mL (ISPD guideline)	First serum concentration is difficult to achieve target. No correlation between serum concentration and clinical efficacy at 10 or 15 μg/mL.
Ma Ying et al.(2023)^[4]	China	56	15 mg/kg vancomycin, administered on Day1, re-dose 0.5 g on Day3 if serum concentration <15 μg/mL; Adjusting dosing regimens based on the serum concentration on Day5.	15 μg/mL (ISPD guideline)	No correlation between serum concentration and clinical efficacy.
Sarah Stevenson et al.(2015)^[9]	Australia	34	30 mg/kg vancomycin (max 2.0 g), check serum concentration every 2-3 days and re-dose 30 mg/kg vancomycin (max 2.0 g) if <15 μg/mL.	15 μg/mL (ISPD guideline)	No correlation between serum concentration and clinical efficacy.

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