复方磺胺甲噁唑及其代谢物血药峰浓度与危重症患者临床疗效及不良反应的相关性研究

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中图分类号R978.2 文献标志码A 文章编号 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

复方磺胺甲噁唑（简称"TMP/SMZ"）由磺胺甲噁唑（sulfamethoxazole，SMZ）和甲氧苄啶（trimethoprim，TMP）按5：1的比例组合而成，其作用机制为SMZ作用于二氢叶酸合成酶，TMP选择性抑制二氢叶酸还原酶；二者合用可使病原菌的叶酸代谢受到双重抑制，干扰菌体蛋白质合成，发挥抗菌活性]。（剩余9870字）