max</sub>) 與危重癥患者臨床療效及不良反應(yīng)的相關(guān)性。方法回顧性收集2023年12月至2025年1月海南省人民醫(yī)院重癥監(jiān)護(hù)室(ICU)使用TMP/SMZ治療的危重癥患者資料，按治療后是否成功分為成功組和失敗組。采用簡(jiǎn)單線性回歸和Spearman相關(guān)分析法分析TMP c<sub>max</sub> 、SMZ c<sub>max</sub> 及NSMZ c<sub>max</sub> 與臨床療效及不良反應(yīng)的相關(guān)性;采用受試者工作特征曲線(ROC)預(yù)測(cè)不良反應(yīng)發(fā)生時(shí)的截?cái)嘀?。結(jié)果在入住ICU 24h 內(nèi)急性生理與慢性健康評(píng)分I（APACHE-I） ?15 分的危重癥患者中，成功組患者的SMZ c<sub>max</sub> 顯著高于失敗組( P< 0.05)。TMP/SMZ每日總劑量與 <img src="/qkimages/zgyf/zgyf202514/zgyf20251415-1-l.jpg" with="158px" style="vertical-align: middle;"> 呈正相關(guān) (P<0.05) 。TMP c<sub>max</sub> 與肝毒性和腎毒性、SMZ c<sub>max</sub> 與肝毒性、NSMZc<sub>max</sub> 與腎毒性有相關(guān)性( (P<0.05) 。 TMPc<sub>max</sub> 預(yù)測(cè)腎毒性和肝毒性的截?cái)嘀捣謩e為 7.25,6.63μg/mL ,SMZ c<sub>max</sub> 預(yù)測(cè)肝毒性的截?cái)嘀禐?138.00μg/mL ,NSMZ c<sub>max</sub> 預(yù)測(cè)腎毒性的截?cái)嘀禐?60.76μg/mL 。結(jié)論入住ICU24h內(nèi)APACHE- I?15 分的危重癥患者中，SMZ c<sub>max</sub> 與治療成功存在關(guān)聯(lián)。TMP c<sub>max</sub>?6.63μg/mL.SMZc<sub>max</sub>?138.00μg/mL 時(shí)，患者的肝毒性發(fā)生風(fēng)險(xiǎn)顯著增加;TMP c<sub>max</sub>? 7.25μg/mL 、NSMZ c<sub>max</sub>?60.76μg/mL 時(shí)，患者的腎毒性發(fā)生風(fēng)險(xiǎn)顯著增加。-龍?jiān)雌诳W(wǎng)" />

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復(fù)方磺胺甲噁唑及其代謝物血藥峰濃度與危重癥患者臨床療效及不良反應(yīng)的相關(guān)性研究

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中圖分類號(hào)R978.2 文獻(xiàn)標(biāo)志碼A 文章編號(hào) 1001-0408（2025）14-1775-06

DOI 10.6039/j.issn.1001-0408.2025.14.15

ABSTRACT OBJECTIVE To analyze the correlation of the peak blood concentration （ ）of compound sulfamethoxazole （TMP/SMZ）and its metabolite N. acetyl sulfamethoxazole （NSMZ）with clinical efficacy and adverse reactions in critically ill patients.METHODSThedataofcriticallyillpatientstreatedwithTMP/SMZinvariousICUofHainanGeneralHospitalfrom December 2023 to January 2025wereretrospectivelycolected.Thepatients were divided intosuccessgroupandfailuregroup basednthetreatmentoutcome.Simplelinearregressonand Speamancorelationanalysiswereused toanalyzethecorelationof TMP cmax ，SMZ cmax ，andNSMZ cmax with clinical efficacy and adverse reactions.The receiver operating characteristic curve （ROC） was used to determine the cutoff values of cmax forpredicting the occurrence of adverse reactions. REsULTS Among critically ill patients with an acute physiology and chronic health evaluation I （APACHE- II） ?15 points 24h of check-in at ICU，SMZ cmax of success group was significantly higher than failure group （ （P<0.05 ）. The daily total dose of TMP/SMZ was positively correlated with TMP cmax and SMZ cmax （ ΔP<0.05 ）.TMP cmax was significantly correlated with hepatotoxicity and nephrotoxicity，SMZ cmax with hepatotoxicity，and NSMZ cmax with nephrotoxicity（ P< 0.05）.The cutoff values of TMP cmax for predicting nephrotoxicity andhepatotoxicity were 7.25μg/mL and 6.63μg/mL ，respectively. The cutoff value of SMZ cmax forpredicting hepatotoxicity was 138.00μg/mL ，and thatofNSMZ cmax forpredicting nephrotoxicity was 60.76μg/mL CONCLUSIONS Among criticallyill patients with an APACHE- I?15 points 24h of check-in at ICU，SMZ cmax is associated with treatment success.Hepatotoxicity risk significantly increases when TMP cmax≥6.63μg/mL or SMZ cmax≥138.00μg/mL ； nephrotoxicity risk significantly increases when TMP cmax?7.25μg/mL or NSMZ cmax?60.76μg/mL ： KEYWORDS compound sulfamethoxazole; N. -acetyl-sulfamethoxazole；critically ill patients；peak blood concentration；clinical efficacy；adverse reactions

復(fù)方磺胺甲噁唑（簡(jiǎn)稱"TMP/SMZ"）由磺胺甲噁唑（sulfamethoxazole，SMZ）和甲氧芐啶（trimethoprim，TMP）按5：1的比例組合而成，其作用機(jī)制為SMZ作用于二氫葉酸合成酶，TMP選擇性抑制二氫葉酸還原酶；二者合用可使病原菌的葉酸代謝受到雙重抑制，干擾菌體蛋白質(zhì)合成，發(fā)揮抗菌活性]。（剩余9870字）

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