夫西地酸致药源性血小板减少症1例并文献复习  

Drug-induced thrombocytopenia induced by Fucididic Acid:a case report and literature review

作　　者：萧鲲 张翠玲[1] XIAO Kun;ZHANG Cuiling(The Affiliated Brain Hospital of Guangzhou Medical University,Guangdong Province,Guangzhou510000,China)

机构地区：[1]广州医科大学附属脑科医院,广东广州510000

出　　处：《中国医药导报》2021年第12期190-192,196,F0003,共5页China Medical Herald

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项项目(2017YFC1310601);广东省广州市中医药和中西医结合科技项目(20192A010015)。

摘　　要：药源性血小板减少症(DITP)是指药物导致血小板计数低于正常范围(<100×109/L)而导致出血等症状的疾病。笔者接诊1例抗甲氧西林金黄色葡萄球菌所致肺部感染患者,在应用常规剂量夫西地酸(FA)抗感染治疗过程中出现血小板减少症,确诊为DITP。经停药和严密监护等治疗后血小板计数恢复至参考值范围水平。本例患者预后良好,但值得临床反思和经验总结:首先,目前已有较多关于头孢菌素类、利奈唑胺导致DITP的病例报道,但关于FA引起的血小板减少症的报道罕见,需要进行病例报道以提高临床警惕性;其次,严重感染及抗生素均可致血小板减少,需要讨论因果关系判断和总结临床特征以做好诊断与鉴别诊断;再次,DITP的发生包括多个机制,针对不同机制所致DITP治疗方法不一,需要分析FA引起DITP的机制和探讨其治疗方案。为此,本文通过对1例患者诊治经过进行报道和对相关文献进行复习,介绍FA所致DITP的诊断、临床特征、治疗、预后和发病机制,以期提高临床医师对此病的认识度和警惕性,做到及早诊断、及时治疗和改善预后。Drug-induced thrombocytopenia(DITP)refers to a disease in which the platelet count is lower than the normal range(<100×109/L)caused by drugs,resulting in bleeding and other symptoms.A patient who the author accepted with pulmonary infection caused by methicillin resistant Staphylococcus aureus developed thrombocytopenia during the course of anti-infection treatment with conventional Fusidic Acid(FA),and was diagnosed as DITP.After treatment with discontinuance of medication and intensive monitoring,the platelet count returned to the reference range.The prognosis of this patient is good,but it is worth clinical reflection and experience summary:first of all,there have been many case reports on DITP caused by cephalosporins and Linezolid,but there are few reports on FA induced thrombocytopenia,and case reports are needed to improve clinical vigilance;secondly,both severe infection and antibiotics can cause thrombocytopenia,so it is necessary to discuss the causal relationship,judge and summarize the clinical features to make a good diagnosis and differential diagnosis;thirdly,the occurrence of DITP includes multiple mechanisms,and the treatment methods for DITP caused by different mechanisms are different,so it is necessary to analyze the mechanism of DITP caused by FA and explore its treatment plan.Therefore,this paper reports the diagnosis and treatment of one patient and reviews the relevant literature,introduces the diagnosis,clinical features,treatment,prognosis and pathogenesis of DITP caused by FA,in order to improve the awareness and vigilance of clinicians,so as to make early diagnosis,timely treatment and improve the prognosis.

关 键 词：夫西地酸 抗生素 药源性 血小板减少症 

分 类 号：R595.3[医药卫生—内科学]