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目的:循证评价万古霉素血药峰浓度与临床结局的相关性。方法:系统检索英文数据库(Pub Med、Embase、the Cochrane Library)和中文数据库(CNKI、Wan Fang、CBM),获取公开发表关于万古霉素血药峰浓度和临床结局相关性的研究,对纳入研究进行描述性分析。结果:纳入6篇观察性研究,共971例患者。4篇研究评价万古霉素血药峰浓度与临床疗效的关系(有2篇按临界值分组),其中仅1篇研究显示峰浓度>25 mg·L-1时可显著提高临床疗效,其余研究均显示血药峰浓度高低与临床疗效无相关性;4篇研究评价血药峰浓度和肾毒性的关系(2篇按临界值分组),3篇研究显示两组患者血药峰浓度高低与肾毒性无相关性。结论:现有证据无法支持万古霉素血药峰浓度与临床结局之间具有确定的相关性。
Objective: To evaluate the correlation between vancomycin peak plasma concentration and clinical outcome. Methods: PubMed, Embase, the Cochrane Library and Chinese database (CNKI, Wan Fang, CBM) were searched to obtain the published research about the relationship between vancomycin peak plasma concentration and clinical outcome. Descriptive analysis. RESULTS: Six observational studies were included, 971 patients in total. Four studies evaluated the relationship between peak vancomycin plasma concentrations and clinical outcomes (two were grouped by cut-off value), of which only one study showed a significant increase in clinical efficacy at peak concentrations> 25 mg · L-1. Other studies Showed no correlation between the peak plasma concentration and clinical efficacy; 4 studies evaluated the relationship between peak plasma concentration and nephrotoxicity (2 by the critical value group), 3 studies showed that the two groups of patients with peak plasma concentration of kidney and kidney No relevant toxicity. CONCLUSIONS: The available evidence does not support the definitive correlation between vancomycin peak plasma levels and clinical outcome.