心脏外科手术后应用利奈唑胺致血小板减少的特征及因素分析  

Characteristics of linezolid-induced thrombocytopenia after cardiac surgery and risk factors analysis

作　　者：黄燕[1,3] 杨春兰 苏涌[1,3] 林敏 夏泉[1,3] 许杜娟 HUANG Yan;ANG Chun-lan;SU Yong;LIN Min;XIA Quan;XU Du-juan(Department of Pharmacy,the First Affiliated Hospital of Anhui Medical University,Hefei ANHUI 230032,China;Pepartment of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei ANHUI 230032,China;The Grade 3 Pharmaceutical Chemistry Laboratory of State Administration,Hefei ANHUI230032,China)

机构地区：[1]安徽医科大学第一附属医院药剂科,安徽合肥230032 [2]安徽医科大学第一附属医院心脏大血管外科,安徽合肥230032 [3]国家中医药管理局中药化学三级实验室,安徽合肥230032

出　　处：《中国新药与临床杂志》2023年第8期532-536,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：国家自然科学基金面上项目(82174011)。

摘　　要：目的探讨心脏外科手术后应用利奈唑胺患者血小板计数减少的发生情况,分析可能的危险因素。方法回顾性收集本院2019年7月至2021年12月期间心脏外科手术后应用利奈唑胺治疗的患者病例资料,采用单因素及多因素logistic回归分析收集的临床资料,筛选出利奈唑胺相关血小板减少的危险因素。结果共纳入有效病例93例,其中39例患者在治疗期间发生血小板减少,发生率为42%,发生时间为用药后1~17 d,中位时间为5 d。多因素logistic回归分析显示,用药疗程为心脏外科手术后患者发生利奈唑胺相关血小板减少的独立危险因素,用药时间每增加1 d,血小板减少发生风险增加11.1%(OR=1.111,95%CI:1.024~1.204,P=0.011);而估算的肾小球滤过率(e GFR)水平(OR=0.982,95%CI:0.970~0.995,P=0.007)和合用华法林(OR=0.216,95%CI:0.072~0.648,P=0.006)为利奈唑胺相关血小板减少的保护因素,e GFR每增加1个单位,血小板减少发生风险降低1.8%,未合用华法林组发生风险为合用组的4.63倍。结论心脏外科手术后患者应用利奈唑胺发生血小板减少风险较高,尤其是用药时间长、肾功能不全及治疗期间未合用华法林的患者。AIM To investigate characteristics of linezolid-induced thrombocytopenia in patients after cardiac surgery,and to identify the possible risk factors.METHODS Clinical data from medical records of patients who were treated with linezolid from July 2019 to December 2021 was retrospectively retrieved.Univariate and multifactorial logistic regression were used to analyze the risk factors of linezolid-induced thrombocytopenia.RESULTS Totally 93cases were included,among which 39 patients(42%)developed thrombocytopenia.The occurrence time was from 1 to 17days after treatment,with a median time of 5 days.Multivariate analysis indicated that the duration of medication was an independent risk factor for linezolid-induced thrombocytopenia in patients after cardiac surgery,and the risk of thrombocytopenia increased by 11.1%for each one day increase of medication duration(OR=1.111,95%CI:1.024 to 1.204,P=0.011).The estimate glomerular filtration rate(eGFR)level(OR=0.982,95%CI:0.970 to 0.995,P=0.007)and combination of warfarin(OR=0.216,95%CI:0.072 to 0.648,P=0.006)were protective factors for linezolid-induced thrombocytopenia.The risk of thrombocytopenia was reduced by 1.8%for every 1 unit increase of eGFR,and the risk of thrombocytopenia was 4.63 times higher in the non-warfarin combination group than in the warfarin combination group.CONCLUSION Patients treated with linezolid after cardiac surgery have a higher risk of thrombocytopenia,especially with long duration of medication,renal insufficiency and no combination of warfarin.

关 键 词：利奈唑胺 心脏外科手术 血小板减少 危险因素 

分 类 号：R978.1[医药卫生—药品]