目的　探讨革兰阳性球菌重症肺炎患儿万古霉素血药谷浓度的影响因素。方法　收集93例革兰阳性球菌重 症肺炎患儿的一般情况、生化检查结果及万古霉素血药浓度，回顾分析患儿临床资料中与万古霉素血药谷浓度相关的因 素。结果　在万古霉素40~60 mg/(kg·d)的给药方案下，93例革兰阳性球菌重症肺炎患儿中万古霉素血药谷浓度<10 mg/ L 54例、10~ mg/L26例、≥20 mg/L 13例，三组间谷氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、肾小球滤过率 （GFR）和谷酰转肽酶（γ-GT）水平差异有统计学意义（P均<0.05），其中10~ mg/L组的AST和γ-GT最高，≥20 mg/L组 ALT最高而GFR最低。多重线性回归分析发现，GFR与万古霉素血药谷浓度间存在负线性相关关系（R2=0.039， P＜0.05）。 GFR≥90 mL/(min·1.73m2)、60≤GFR≤89 mL/(min·1.73m2)、30≤GFR≤59 mL/(min·1.73m2)组患儿对应万古霉素 血药谷浓度中位数分别为8.7 mg/L、18.2 mg/L、6.5 mg/L，差异有统计学意义（P均<0.05）。 结论　革兰阳性球菌重症肺 炎患儿万古霉素血药谷浓度与GFR水平呈负相关，合并肾功能轻度损害者更易达到万古霉素目标血药谷浓度值。临床上 应以指南推荐的较低剂量使用万古霉素，并注意密切监测其血药谷浓度。

　Objective　To explore the factors influencing serum trough concentration of vancomycin in pediatric patients with severe gram-positive cocci pneumonia. Methods　The general information, the biochemical test results, and plasma concentration of vancomycin were collected from 93 pediatric patients with severe gram-positive cocci pneumonia. The relative factors influencing trough concentration of vancomycin were analyzed retrospectively.  Results　With the dosage of 40-60 mg/ (kg·d), serum trough concentration of vancomycin were between 10-20 mg/L in 26 patients, <10 mg/L in 54 cases, ≥20 mg/L in 13 cases. The ALT, AST, GFR, and γ-GT were significantly different among three groups (P<0.05); the 10-20 mg/L group had the highest levels of AST and γ-GT, the ≥20 mg/L group had the highest level of ALT and the lowest level of GFR. Multiple linear regression analysis showed that GFR was negatively linearly correlated with the serum trough concentration of vancomycin (R2=0.039, P<0.05). The median serum trough concentration of vancomycin in pediatric patients with GFR≥90, 60?90, 30?60 mL/(min·1.73m2) were 8.66, 18.21, 8.45 mg/L respectively, and the difference is statistically significant (P<0.05). Conclusions The serum trough concentration of vancomycin is negatively linearly correlated with GFR in pediatric patients with severe grampositive cocci pneumonia. The patients with impaired renal function are easier to reach the target serum trough concentration of vancomycin. Clinical use of vancomycin should follow the low doses in the range the guideline recommended, and the serum trough concentration should be closely monitored.