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目的了解多黏菌素肾毒性的研究情况与临床特征,为临床安全使用多黏菌素提供参考。方法以“polymyxin”、“colistin”、“colistimethate”、“nephrotoxicity”、“renal toxicity”和“多黏菌素”、“黏菌素”、“肾毒性”为检索词,检索PubMed、Embase、Web of Science、中国生物医学期刊引文数据库和中国生物医学文献数据库关于多黏菌素肾毒性的文献。用Excel表对最终纳入的文献建立评价数据库,记录文献语种、文献类型、发表年代、发文量排序前5位的国家和研究机构、载文量前5位的期刊、被引频次前10位的文献,分析有关文献的研究内容和热点,总结多黏菌素肾毒性的临床表现、发生机制及防治措施。结果共纳人文献95篇,其中英文91篇,中文2篇,法文和葡萄牙文各1篇。论著82篇,综述13篇。首次发表多黏菌素肾毒性文献的时间是1952年。发表论文数量居前5位的国家分别是美国(29篇)、希腊(12篇)、土耳其(8篇)、澳大利亚(6篇)、韩国(5篇)。文献的最高被引频次为156次。多黏菌素的给药方式为静脉滴注和雾化给药。肾损伤多出现在用药后4~10 d。主要临床表现为肌痛、无力、尿液颜色变深、血尿、蛋白尿等。实验室检查显示血清肌酐含量升高和肌酐清除率降低。出现肾损伤后立即停药,并采取对症治疗,部分患者的肾功能可恢复到用药前状态。多黏菌素肾毒性的发生率随给药剂量增加而升高,随延长给药间隔而降低。多黏菌素肾毒性的机制尚不清楚,可能与增加细胞膜通透性及改变输尿管上皮细胞跨膜电位有关。结论希腊对多黏菌素肾毒性的研究处于领先地位。高质量的论著更受研究者关注。减少用药剂量、延长用药间隔、联用具有保护肾功能作用的药物能减轻多黏菌素肾毒性程度。一旦发生多黏菌素所致肾损伤,应立即停药并对症治疗。
Objective To understand the research situation and clinical features of polymyxin nephrotoxicity and provide references for clinical use of polymyxin. Methods “polymyxin”, “colistin”, “colistimethate”, “nephrotoxicity”, “renal toxicity” and “polymyxin”, “ ”Nephrotoxicity " as the search term to search for the literature on polymyxin nephrotoxicity in PubMed, Embase, Web of Science, China Biomedical Journals Citation Database and China Biomedical Literature Database. Use Excel to establish the evaluation database for the finally incorporated documents, record the top five countries and research institutes for the literature languages, document types, published years, and the top five papers published, the top 5 papers cited, the top 10 cited Literature, analysis of the literature research content and hot spots, summarize the clinical manifestations of polymyxin nephrotoxicity, its mechanism and prevention and treatment measures. Results A total of 95 people were enrolled in the literature, including 91 English, 2 Chinese, 1 French and 1 Portuguese. 82 articles, 13 articles. The first published polymyxin nephrotoxicity literature in 1952. The top 5 countries that published papers are the United States (29), Greece (12), Turkey (8), Australia (6) and South Korea (5). The highest frequency of citations was 156 times. Polymyxin administration by intravenous infusion and atomization. Kidney damage occurred more after 4 ~ 10 d. The main clinical manifestations of myalgia, weakness, dark urine, hematuria, proteinuria and so on. Laboratory tests showed elevated serum creatinine and decreased creatinine clearance. Renal injury immediately after withdrawal and take symptomatic treatment, some patients with renal function can be restored to the state before treatment. The incidence of polymyxin nephrotoxicity increased with the dose increased, with prolonged dosing interval decreased. The mechanism of polymyxin nephrotoxicity is not clear, may be related to increasing cell membrane permeability and changing the transmembrane potential of ureteral epithelial cells. Conclusions Greece is a leader in the study of polymyxin nephrotoxicity. High-quality works by researchers more attention. Reduce the dose, prolong the interval of medication, combined with the role of drugs to protect renal function can reduce the degree of polymyxin nephrotoxicity. In the event of polymyxin-induced renal damage, should be immediately discontinued and symptomatic treatment.