肝硬化患者利奈唑胺相关血小板减少症的危险因素分析  

Risk factors of linezolid-related thrombocytopenia in patients with liver cirrhosis

作　　者：蔡妙甜[1] 李侗曾[1] 段忠辉[1] 牟丹蕾[1] 梁连春[1] CAI Miaotian;LI Tongzeng;DUAN Zhonghui;MOU Danlei;LIANG Lianchun(Integrated Department of Infectious Diseases,Beijing You-an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合科,北京100069

出　　处：《中国感染与化疗杂志》2018年第2期156-162,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的了解肝硬化患者利奈唑胺治疗导致血小板减少症的情况并评估相关危险因素。方法回顾性分析2013年1月-2017年5月接受利奈唑胺治疗的肝硬化患者的病历资料,分析利奈唑胺治疗时血小板计数的变化,利用单因素及多因素逐步Logistic回归分析利奈唑胺相关血小板减少症的危险因素,通过Cox回归模型评价利奈唑胺相关血小板减少症对肝硬化患者院内病死率的影响。结果共纳入有效病例52例,肝硬化患者利奈唑胺相关血小板减少症(血小板计数≤50×10~9/L且减少≥25%基线值)累积发生率为51.9%(27/52),其中严重血小板减少症(血小板减少≥50%基线值)比例为85.2%(23/27)。多因素逐步Logistic回归分析显示基线血小板计数≤110×10~9/L(OR=6.989,95%CI:1.192~40.971,P=0.031)、利奈唑胺疗程≥7 d(OR=9.478,95%CI:1.349~66.587,P=0.024)及剂量≥17 mg·kg^(-1)·d^(-1)(OR=0.062,95%CI:0.010~0.383,P=0.003)为肝硬化患者发生利奈唑胺相关血小板减少症的独立危险因素。Cox回归模型分析提示肝硬化患者院内病死率与利奈唑胺相关血小板减少症间无显著相关性(P>0.05)。结论利奈唑胺相关血小板减少症在肝硬化患者中发生率较高,但并未显著加剧治疗期间患者脏器出血及院内死亡风险;对于基线血小板计数较低、利奈唑胺疗程较长的肝硬化患者应加强血小板等指标的监测以减少严重药物不良反应的发生。Objective To investigate the incidence and potential risk factors of linezolid(LZD)related thrombocytopenia(TP)in patients with liver cirrhosis(LC).Methods Clinical data of LC patients treated with LZD for at least 1 dose(600 mg per 12 h)between January 2013 and May 2017 were retrospectively collected and analyzed to investigate the incidence and risk factors of LZD-related TP defined as platelet count during LZD therapy≤50×109/L or a decline by≥25%of the baseline level.Results A total of 52 patients with LC were included in this study.The cumulative incidence of LZD-related TP was 51.9%(27/52),of which 85.2%(23/27)was severe TP(decline of platelet count by≥50%of the baseline level).Multivariate logistic regression analysis showed that the baseline platelet count≤110×109/L(OR=6.989,95%CI:1.192-40.971,P=0.031),LZD course≥7 d(OR=9.478,95%CI:1.349-66.587,P=0.024)and LZD dose≥17 mg·kg-1·d-1(OR=0.062,95%CI:0.010-0.383,P=0.003)were independent risk factors of LZD-related TP in LC patients.Kaplan-Meier analysis revealed that the overall median time from the initiation of LZD therapy to in-hospital death was 18 days in TP patients and 13 days in non-TP patients without significant difference(P>0.05).Cox proportional-hazards regression revealed no significant correlation between the in-hospital mortality and LZD-related TP in LC patients(P>0.05).Conclusions Patients with LC are at high risk of LZD-related TP,but not associated with organ hemorrhage during LZD therapy and in-hospital mortality.Platelet count should be monitored more closely during LZD therapy for LC patients with lower baseline platelet count and longer LZD course.

关 键 词：肝硬化 利奈唑胺 血小板减少症 危险因素 

分 类 号：R575.2[医药卫生—消化系统] R558.2[医药卫生—内科学]