利奈唑胺致老年患者血液毒性的相关危险因素分析  

Risk factors for development of hematotoxicity in elderly patients treated with Linezolid

作　　者：柏淑禹[1] 苏爱梅 杨帆[1] 杨立 Bo Shuyu;Su Aimei;Yang Fan;Yang Li(Department of Geriatrics,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院医科大学附属鼓楼医院老年医学科,南京210008

出　　处：《中华结核和呼吸杂志》2022年第6期533-538,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：江苏省卫生厅干部保健科研资助项目(BJ16006)。

摘　　要：目的分析应用利奈唑胺的老年住院患者临床资料,尤其是发生血液毒性的状况,并对相关危险因素进行探讨。方法选取南京大学医学院附属鼓楼医院2018年1月至2021年9月、接受利奈唑胺治疗老年住院患者为研究对象,查阅信息系统数据,回顾性分析其临床资料特征,尤其是发生血药毒性反应患者的临床特点及相关危险因素。结果纳入有效病例233例,利奈唑胺经验性使用率为44.21%(103/233),总有效率为76.39%(178/233)。监测血药浓度的有效病例57例中,36.84%(21/57)的老年患者利奈唑胺谷浓度偏高。单纯血小板减少15例,单纯血红蛋白减少3例、血小板和血红蛋白均减少3例。发生血液毒性组[出现一定程度的血红蛋白和(或)血小板减少]的患者合并肾功能损伤(χ^(2)=6.642,P=0.036)、同时应用质子泵抑制剂者(χ^(2)=4.566,P=0.033)多于无血液毒性组患者(χ^(2)=6.642,P=0.036;χ^(2)=4.566,P=0.033),且利奈唑胺疗程更长(P=0.041)。利奈唑胺谷浓度与MDRD公式评估的肾小球滤过率(eGFRMDRD)之间,无线性相关性(R=0.226,P=0.136)。结论老年患者,尤其是肾功能受损、疗程长、同时应用质子泵抑制剂治疗者,应用利奈唑胺治疗时出现血液毒性的风险更高。应加强老年患者肾功能的保护,减少药物相互作用,动态监测利奈唑胺血药浓度,调整利奈唑胺剂量,实现更加安全有效的治疗。Objective To analyze the clinical data,especially the occurrence of hematotoxicity,of hospitalized elderly patients who took Linezolid(LZD),and to further explore the related risk factors.Methods Our study enrolled the elderly inpatients treated with linezolid at the Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2018 to September 2021.The hospital information system data were retrieved to retrospectively analyze the clinical characteristics of patients,particularly the clinical characteristics and related risk factors of patients who experienced hematotoxic reactions to LZD.Results Of the 233 eligible cases included,103 patients received empirical use of LZD(44.21%).The total effective rate was 76.39%(178/233).Among the 57 effective cases who received blood drug concentration monitoring,the trough concentration of LZD was high in 36.84%(21/57)of elderly patients.Moreover,there were 15 patients with thrombocytopenia alone,3 patients with decreased hemoglobin(HB)alone,and 3 patients with both thrombocytopenia and HB decrease.The patients who experienced hematotoxicity(developed a certain degree of hemoglobin decrease and/or thrombocytopenia)were more likely to be complicated with renal impairment(χ²=6.642,P=0.036),concomitantly using proton pump inhibitor(PPI)(χ²=4.566,P=0.033),and had a longer course of LZD treatment(P=0.041).There was no linear correlation between the trough concentration of LZD and glomerular filtration rate evaluated by Modification of Diet in Renal Disease Formula(eGFRMDRD)(R=0.226,P=0.136).Conclusions The elderly patients,especially those with renal impairment,concomitant treatment with PPI,and a longer course of LZD treatment,exhibited a higher risk of hematotoxicity during LZD treatment.Hence,we should strengthen the protection of renal function,reduce drug interaction,and dynamically monitor the blood drug concentration of LZD to adjust its dose,thus implementing safer and more effective treatments.

关 键 词：利奈唑胺 毒效应 血液 肾功能不全 质子泵抑制剂 老年患者 

分 类 号：R969[医药卫生—药理学]