肝移植患者应用利奈唑胺发生相关血小板减少的危险因素分析  

Risk factors for linezolid-induced thrombocytopenia in liver transplant patients

作　　者：沈赟 秦艳 陈喆 戴佩芳 吕迁洲 叶岩荣 SHEN Yun;QIN Yan;CHEN Zhe;DAI Pei-fang;LV Qian-zhou;YE Yan-rong(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032

出　　处：《中南药学》2020年第8期1381-1386,共6页Central South Pharmacy

基　　金：上海市临床重点专科(临床药学)项目(No.shslczdzk06504)。

摘　　要：目的探讨肝移植患者应用利奈唑胺发生相关血小板减少症的危险因素。方法通过医院的电子病例系统,收集本院2016年1月至2019年12月期间使用利奈唑胺治疗的肝移植患者的病历资料,利用单因素及多因素逐步Logistic回归分析方法对临床资料进行分析,筛选出利奈唑胺相关血小板减少症的危险因素。结果共纳入有效病例57例,所有纳入研究的患者在利奈唑胺开始治疗前血小板均为正常值,其中14例患者在治疗期间发生利奈唑胺相关血小板减少症,发生率为24.6%,停药后所有患者血小板恢复至正常水平的时间为5.0~14.0 d,中位恢复时间为8.0 d。多因素Logistic回归分析显示用药时间>10 d(OR=10.761,95% CI:1.743~66.424,P=0.011),基线血小板<150×109·L-1(OR=16.892,95% CI:2.328~122.553,P=0.005)和合用氟康唑/伏立康唑药物(OR=5.841,95% CI:1.066~31.990,P=0.042)为肝移植患者发生利奈唑胺相关血小板减少症的独立危险因素,此外单因素Logistic回归分析显示肌酐>115 μmol·L-1 和eGFR<60 mL/(min·1.73 m2)在两组间差异存在统计学意义。结论血小板正常的肝移植患者,利奈唑胺治疗过程中仍需警惕血小板减少症的发生,尤其是用药时间超过10 d,基线血小板小于150×109·L-1及治疗期间合用氟康唑/伏立康唑的患者。Objective To identify the risk factors for linezolid-induced thrombocytopenia in liver transplant patients.Methods We retrospectively retrieved the clinical data from medical records of liver transplant in-patients from January 2016 to December 2019 who underwent linezolid therapy.Univariate and multi-variate Logistic regression analyses were used to identify the risk factors for linezolid-induced thrombocytopenia.Results Totally 57 liver transplant patients were included in our research and the baseline platelet was normal before the treatment.Fourteen (24.6%) developed thrombocytopenia.Time of platelet value returning to normal lasted 5.0 to 14.0 days in all patients after withdrawing linezolid and the median recovery time was 8.0 days.Multivariate analysis indicated that the duration of linezolid therapy over 10 days (OR=10.761,95% CI:1.743~66.424,P=0.011),baseline platelet below 150×109·L-1 (OR=16.892,95% CI:2.328~122.553,P=0.005) and combination with fluconazole/voriconazole (OR=5.841,95% CI:1.066~31.990,P=0.042) were the independent risk factors for linezolid-induced thrombocytopenia in liver transplant patients.In addition,univariate analysis showed creatinine>115 μmol·L-1 and eGFR<60 mL/ (min·1.73 m2) were also associated with thrombocytopenia (P<0.05).Conclusion For liver transplant patients with normal platelet before linezolid treatment,thrombocytopenia should be cautioned especially for those with linezolid therapy over 10 days,baseline platelet below 150×109·L-1 and combination with fluconazole/voriconazole.

关 键 词：利奈唑胺 肝移植 血小板减少 危险因素 

分 类 号：R575.2[医药卫生—消化系统]