目的:尽管已在临床上用于治疗感染,多粘菌素B(PMB)的治疗范围有限,伴随着其药代动力学的相当大的患者间差异和急性肾损伤的频繁发生,严重阻碍了它的广泛应用。最近对PMB群体药代动力学的研究提供了有价值的见解。本研究旨在回顾相关文献,为临床个体化管理奠定理论基础。
方法:遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南,从数据库开始到2023年3月,在PubMed和EMBASE数据库系统中搜索了PMB的Pop-PK研究。
结果:迄今为止,总共进行了22项基于人群的研究,涵盖六个不同国家的756个科目。在这些研究中招募的人群包括感染多重耐药细菌的严重感染者,肾功能不同的患者,那些患有囊性纤维化的人,肾或肺移植受者,接受体外膜氧合(ECMO)或连续肾脏替代疗法(CRRT)的患者,以及肥胖或儿科人群。在这些研究中,七个人采用了一个隔间模型,典型间隙(CL)和容积(Vc)的范围为1.18-2.5L/h和12.09-47.2L,分别。15项研究采用了两室模型,根据中央隔间的间隙(CL)和容积(Vc)的范围,外围隔室的体积(Vp),室间间隙(Q)为1.27-8.65L/h,5.47-38.6L,4.52-174.69L,和1.34-24.3L/h,分别。这些研究中确定的主要协变量包括肌酐清除率和体重,而其他考虑的协变量是CRRT,白蛋白,年龄,和SOFA分数。在19项研究中进行了内部评估,只有一项研究使用独立的外部数据集进行外部验证。
结论:我们得出的结论是,小样本量,缺乏多中心合作,和患者同质性是导致当前研究结果差异的主要原因.此外,大多数研究仅限于内部评估,这限制了模型知情的精确给药策略的实施。
OBJECTIVE: Despite being clinically utilized for the treatment of infections, the limited therapeutic range of polymyxin B (PMB), along with considerable interpatient variability in its pharmacokinetics and frequent occurrence of acute kidney injury, has significantly hindered its widespread utilization. Recent research on the population pharmacokinetics of PMB has provided valuable insights. This study aims to
review relevant literature to establish a theoretical foundation for individualized clinical management.
METHODS: Follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, Pop-PK studies of PMB were searched in PubMed and EMBASE database systems from the inception of the database until March 2023.
RESULTS: To date, a total of 22 population-based studies have been conducted, encompassing 756 subjects across six different countries. The recruited population in these studies consisted of critically infected individuals with multidrug-resistant bacteria, patients with varying renal functions, those with cystic fibrosis, kidney or lung transplant recipients, patients undergoing extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT), as well as individuals with obesity or pediatric populations. Among these studies, seven employed a one-compartmental model, with the range of typical clearance (CL) and volume (Vc) being 1.18-2.5L /h and 12.09-47.2 L, respectively. Fifteen studies employed a two-compartmental model, with the ranges of the clearance (CL) and volume of the central compartment (Vc), the volume of the peripheral compartment (Vp), and the intercompartment clearance (Q) were 1.27-8.65 L/h, 5.47-38.6 L, 4.52-174.69 L, and 1.34-24.3 L/h, respectively. Primary covariates identified in these studies included creatinine clearance and body weight, while other covariates considered were CRRT, albumin, age, and SOFA scores. Internal evaluation was conducted in 19 studies, with only one study being externally validated using an independent external dataset.
CONCLUSIONS: We conclude that small sample sizes, lack of multicentre collaboration, and patient homogeneity are the primary reasons for the discrepancies in the results of the current studies. In addition, most of the studies limited in the internal evaluation, which confined the implementation of model-informed precision dosing strategies.