利奈唑胺治疗中性粒细胞减少血液病革兰阳性球菌感染76例临床分析  

Linezolid in treatment of neutrocytopenia hematopathy patients with gram positive coccobacteria infection.

作　　者：王秀丽[1] 徐明珠[1] 吴德沛[1] 孙爱宁[1] 仇惠英[1] 苗瞄[1] 唐晓文[1] 付铮铮[1] 何广胜[1] 胡晓慧[1] 薛胜利[1] 

机构地区：[1]苏州大学附属第一医院血液科江苏省血液研究所卫生部血栓与止血重点实验室,江苏苏州215006

出　　处：《中国实用内科杂志》2011年第1期76-78,共3页Chinese Journal of Practical Internal Medicine

基　　金：江苏省医学领军人才基金(LJ200626);卫生部专项基金(200802027)

摘　　要：目的分析利奈唑胺治疗中性粒细胞减少血液病患者革兰阳性(G+)球菌感染的疗效和安全性。方法收集2008年8月至2009年5月苏州大学附属第一医院血液科收治的76例中性粒细胞减少疑诊G+球菌感染血液病患者,以利奈唑胺600 mg,每日2次抗感染治疗,从临床表现和病原学方面评价其疗效,同时观察药物不良反应。结果 76例患者总有效率为91.26%。单用利奈唑胺组有效率92.31%;混合感染初始即联合利奈唑胺组有效率92.59%;混合感染初始联合其他抗G+菌药物后换用利奈唑胺组有效率88.89%。3组病例体温控制中位时间分别为3.313、.76及6.58 d。恶性血液病不缓解、长期使用广谱抗生素及合并G-菌感染是影响利奈唑胺疗效的3个重要因素。利奈唑胺不良反应发生率为26.31%,发生肝功能轻度异常患者未予停用利奈唑胺,经保肝治疗后肝功迅速恢复,其余患者均予以停药后3 d至2周后患者。结论利奈唑胺治疗粒细胞减少血液病患者G+菌感染具有明显疗效。轻症感染或病原学检查提示明确G+菌感染病例,针对性单药利奈唑胺即可取得明显疗效。重症混合感染首选联合利奈唑胺者疗效优于利奈唑胺作为二线药物者。恶性血液病完全缓解、避免广谱抗生素长期使用和及时有效病原体检查有助于利奈唑胺发挥抗G+菌感染的疗效。利奈唑胺引发的不良反应较少。Objective To analyze the curative effect and safety of Linezolid in treatment of neutrocytopenia hematopathy patients with G ＋ coccobacteria infection. Methods Totally 76 neutrocytopenia hematopathy patients suspected of G ＋ coccobacteria infection,were treated with linezolid（600 mg,once every 12 hours）. We evaluated the curative effect based on clinical situation and aetiology;meanwhile,we observed the drug adverse reaction. Resuits The total effeclive rate of linezolid was 91.26%. For 13 patients only having linezolid,the effective rate was 92. 31% ;for ：27 patients treated with linezolid from the beginning of combined infection, effective rale was 92. 59% ;for 36 patients treated with other anti-G ＋ coccobacteria drugs from the beginning of combined infection then changed to linezolid, effective rate was 88.89%. The body temperature control meso-time were 3.31 days, 3.76 days and 6. 58 clays in the 3 groups. In complete remission in malignancy hematopathy,long term use of antibiotic and affiliating G coccobaeteria were the three main factors against the curative effect of linezolid. The adverse effect incidence rate was 26. 31% ;8 patients recovered from slight abnormal liver function or renal function one week after stopping linezolid. Conclusion Linezolid is eftective in treating granulocytopenia hematopathy patients＇ G ＋ coccobacteria infection. When using only linezolid in the case of mild G ＋ coccobacteria infection,the curative effect is obvious. It＇s better for severe polyinfection to use ]inezolid at the beginning. Malignancy hematop-athy complete remission,avoidance of long term antibiotic use and timely and effective pathogen inspection are three factors to emhance the curative effect of anti G ＋ coccobacteria of linezolid.

关 键 词：利奈唑胺 革兰阳性球菌 粒细胞减少 血液病 

分 类 号：R5[医药卫生—内科学]