利奈唑胺治疗感染性心内膜炎临床分析  

Clinical analysis of infective endocarditis treated with linezolid

作　　者：卢芬[1] 何朝生[1] 胡湘明[1] 张莉滟[1] 李晓明[1] 廖火生[1] 林蔡弟[1] LU Fen;HE Chao-sheng;HU Xiang-ming;ZHANG Li-yan;LI Xiao-ming;LIAO Huo-sheng;LIN Cai-di(Department of General Medicine, Pingzhou Branch of Guangdong Provincial People's Hospital (Guangdong Provincial Academy o f Medical Sciences), 528251 Foshan, China.)

机构地区：[1]广东省人民医院广东省医学科学院平洲分院综合内科,佛山1528251

出　　处：《中国循证心血管医学杂志》2016年第11期1333-1336,1344,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：广东省科技计划(2014A020290010);广东省医学科学技术研究基金项目(A2016386)

摘　　要：目的探讨利奈唑胺治疗感染性心内膜炎（IE)的疗效及安全性。方法纳人2009年1月~2015年3月间于广东省人民医院平洲分院收治的诊断为感染性心内膜炎并使用利奈唑胺抗感染治疗的住院患者11例，分析其临床特点及使用利奈唑胺治疗IE的临床疗效及不良反应。结果人选患者男性6例，女性5例，平均年龄（47.0±19.4)岁；既往心脏病史：二尖瓣脱垂3例，风湿性心脏病瓣膜置换术后3例（其中1例安装起搏器），既往感染性心内膜炎病史2例，先天性心脏病史1例，无心脏病史2例；心脏瓣膜损害情况：左心自体瓣膜4例，右心自体瓣膜1例，左右心自体瓣膜1例，人工瓣膜5例；病原菌：粪肠球菌3例，丙酸丙酸杆菌1例，路邓葡萄球菌1例，金黄色葡萄球菌2例，表皮葡萄球菌1例，血链球菌1例，血培养阴性2例；血培养阳性细菌对糖肽类及噁唑酮类抗菌药物均敏感；心脏超声情况：单纯瓣膜赘生物形成5例，赘生物并穿孔3例，赘生物并瓣周脓肿1例，单纯瓣膜脓肿2例；治疗情况：急诊手术1例，择期手术4例，保守治疗6例，治愈10例，治愈率达90.90%;使用利奈唑胺时间5~56d，平均(23.6±16.2)d;随访时间最短6个月，最长4年无复发；主要不良反应为血小板减少，总共有6例，占54.55%c，患者停药和输注血小板或予重组人血小板生成素治疗后均恢复正常。结论利奈唑胺治疗IE临床疗效好，主要不良反应为血小板减少，是一种可逆性不良反应。Objective To investigate the curative effect and safety of linezolid in treatm ent of infectiveendocarditis(IE).Methods The patients(n=11)diagnose with IE and treated with linezolid in the PingzhouBranch of Guangdong Provincial P eople’s Hospital were chosen from Jan.2009to Mar.2015.The clinicalcharacteristics of the patients,and curative effect and adverse reactions of linezolid were analyzed.Results Therewere6male patients and5female ones among all patients,and the average age(47.0±19.4).Among all patients,there were3with m itral valve prolapsed,3with valve replacem ent after rheum atic heart disease(one of themim planted pacem aker),2with history of IE,1with history of congenital heart disease,and2without history ofheart disease.There were4cases with left autologous valve IE,1with right autologous valve IE,1with left-rightautologous valve IE,and5with artificial valve IE.There were3cases with infection of enterococcus faecalis,1with propionibacterium,1with staphylococcus lugdunensis,2with staphylococcus aureus,1with staphylococcusepiderm idis,1with streptococcus sanguis,and2with negative blood culture results.Blood culture positivebacteria were sensitive to glycopeptides antibiotics and oxazolidinone antibiotics.There were5cases with simplevalvular vegetation,3with vegetation and perforation,1with vegetation and paravalvular abscess,and2with simplevalvular abscess.There was1case with emergency surgery,and there were4with selective surgery and6withconservative treatment.There were10cases cured and the cure rate was90.90%.The duration of taking linezolidwas from5d to56d and average day=(23.6±16.2).The shortest follow-up time was6m and the longest time of no recurrence was4y.The major adverse reaction was thrombocytopenia.There were totally6cases(54.55%)with thrombocytopenia,and they recovered after stopping medication,transfusing platelet or giving recombinanthuman thrombopoietin(rhTPO).Conclusion Linezolid is effective to IE in clinic.The major adverse reaction wasthrombocytopenia,which is a reversible adver

关 键 词：利奈唑胺 感染性心内膜炎 临床疗效 血小板减少 

分 类 号：R542.4[医药卫生—心血管疾病]