哌拉西林/三唑巴坦针剂致罕见血小板减少的临床与机制分析  

The Clinical Character and Mechanism under Thrombocytopenia Induced by Tazobactam/Piperacillin

作　　者：陈红[1] 范震[1] 孙敏[1] 郭飞[1] 杨玉敏[1] 陈国栋[1] 乐健伟[1] 王志宇[1] 朱永定[1] 朱建华[1] 

机构地区：[1]宁波市第一医院,宁波325000

出　　处：《国外医药（抗生素分册）》2017年第3期133-135,共3页World Notes on Antibiotics

基　　金：宁波市科技计划项目(2013A610234);浙江省自然科学基金(LQ15H150001);浙江省中医药科学研究基金(2015ZA185)

摘　　要：目的分析哌拉西林/三唑巴坦针剂致血小板减少的临床特点,寻找其发病规律,并初步探讨其可能的致病机制。方法搜集患者完整的临床资料,另外抽取患者外周血液4份,各2m L,37℃水浴孵育,分别加入同等剂量的生理盐水,不同浓度的哌拉西林/三唑巴坦药液,进行体外试验,测定处理后4h,12h,24h,48h血小板计数变化,实验3次,取平均值。结果使用哌拉西林/三唑巴坦d1就可看到血小板减少,停用哌拉西林/三唑巴坦针剂后血小板1~2d开始上升,3~5d恢复正常,骨髓穿刺等检查未发现骨髓抑制,外周血浆血小板抗体阴性,补体C3下降。体外试验发现血小板下降的程度与哌拉西林/三唑巴坦的剂量成正相关,而空白对照及头孢吡肟对照组的血小板则无明显变化。结论哌拉西林/三唑巴坦针剂可致可逆性的急剧性血小板减少,且为剂量依赖性,其致病机制可能与骨髓抑制无关,可能为直接激活补体C3导致血小板破坏。临床医生应该引起重视,哌拉西林/三唑巴坦针剂可致血小板减少。Objective To analyze correlation between thromboeytopenia to find the incidence rule, and to explore its possible pathogenesis. Methods and piperacillin- tazobactam injection, Complete clinical data and peripheral blood samples were collected from patients. The blood sample were devided into 4 bottles equally in 37 ℃ water, each 2mL, then added into the same dose Of saline, different concentrations of piperacillin-tazobactam liquid, cefepime respectively. Platelet counts were measured after 4, t2, 24, 48hours. Repeated twice and averaged data. Results Platelets reduced in the first day after using piperacillin-tazobactam. They began to rise after 1-2 days stopping contection to piperacillin-tazobactam, and go back to normal in 3-5 days later. There was no evidence to bone marrow suppression, and peripheral plasma platelet antibody was negative, while complement C3 declined. In vitro testing we found that more dose of piperaciliin-tazobactam used, more fast platelet declined. However, saline and cefepime control groups did not change significantly. Conclusion Piperacillin-tazobactam can cause a sharp reversible thrombocytopenia, which is dose-dependent. Bone marrow suppression may not be under the pathogenesis. Platelets reduction may be related to the activation of complement C3. Doctors should pay more attention to thrombocytopenia caused by piperacillin-tazobactam.

关 键 词：哌拉西林/三唑巴坦 血小板减少 机理 

分 类 号：R978.1[医药卫生—药品]