血液病患者哌拉西林药物抗体临床分析  

Clinical observation of piperacillin antibody in patients with hematological diseases

作　　者：董晓锋 王兰菊 吕震宇 朱琳 周健 王娟 桂瑞瑞 祖璎玲 卢煌莹 DONG Xiaofeng;WANG Lanju;LYU Zhenyu;ZHU Lin;ZHOU Jian;WANG Juan;GUI Ruirui;ZU Yingling;LU Huangying(Department of Blood Transfusion,the Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou,Henan 450008,China;Department of Hematology,the Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou,Henan 450008,China;Department of Blood Transfusion,Huashan Hospital,FudanUniversity,Shanghai 200040,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院输血科,河南郑州450008 [2]郑州大学附属肿瘤医院河南省肿瘤医院血液科,河南郑州450008 [3]复旦大学附属华山医院输血科,上海200040

出　　处：《中华实用诊断与治疗杂志》2023年第11期1171-1175,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190667);河南省科技攻关计划项目(222102310633)。

摘　　要：目的检测使用哌拉西林他唑巴坦钠抗感染治疗的血液病患者哌拉西林药物抗体,探讨其在抗感染治疗方案制订中的作用。方法2020年7月—2021年2月河南省肿瘤医院应用标准剂量哌拉西林他唑巴坦钠抗感染治疗的血液病患者206例,均于首次给药10d后采用微柱凝胶法行哌拉西林药物抗体检测和直接抗人球蛋白试验(DAT)。比较哌拉西林药物抗体阳性与阴性者性别比例、年龄、不同血液系统疾病比例;比较有无输血史者DAT阳性率和哌拉西林药物抗体阳性率;比较DAT阳性与阴性者哌拉西林药物抗体阳性率。结果206例血液病患者中DAT阳性90例,阴性116例;哌拉西林药物抗体阳性28例,阴性178例。哌拉西林药物抗体阳性与阴性者性别、年龄、不同血液系统疾病比率比较差异均无统计学意义(P>0.05)。206例患者中91例有输血史,有输血史者DAT阳性率(51.65%)高于无输血史者(37.39%)(χ^(2)=4.197,P=0.040),哌拉西林药物抗体阳性率(10.99%)与无输血史者(15.65%)比较差异无统计学意义(χ^(2)=0.941,P=0.332)。DAT阳性者中24例哌拉西林药物抗体阳性,DAT阴性者中4例哌拉西林药物抗体阳性,DAT阳性者哌拉西林药物抗体阳性率(26.67%)高于DAT阴性者(3.45%)(χ^(2)=23.262,P<0.001)。结论应用哌拉西林他唑巴坦钠抗感染治疗的血液病患者可产生哌拉西林药物抗体,有输血史对哌拉西林药物抗体检测结果的影响较小,DAT联合哌拉西林药物抗体监测有助于哌拉西林他唑巴坦钠不良反应的鉴别诊断,为及时调整抗菌药物,避免发生药物诱导的免疫性溶血性贫血提供参考。Objective To detect piperacillin antibody in patients with hematological diseases treated with piperacillin-tazobactam sodium,and to explore its role in the formulation of anti-infection therapy.Methods Totally 206patients with hematological diseases were treated with standard dose of piperacillin-tazobactam sodium in Henan Cancer Hospital from July 2020 to February 2021.The piperacillin antibody detection and direct antiglobulin test(DAT)were done with microcolumn gel method 10 days after the first administration.The proportions of different gender,age and hematological diseases were compared between patients with positive and negative piperacillin antibody.The positive rates of DAT and piperacillin antibody were compared between patients with and without history of blood transfusion,and the positive rates of piperacillin antibody were compared between patients with positive and negative DAT.Results Among206 patients with hematological diseases,DAT was positive in 90 patients and negative in 116,and piperacillin antibody was positive in 28 patients and negative in 178.There were no significant differences in the proportions of different gender,age and hematological diseases between patients with positive and negative piperacillin antibody(P>0.05).In206 patients,91 had a history of blood transfusion.The positive rate of DAT was higher in patients with history of blood transfusion(51.65%)than that in patients without history of blood transfusion(37.39%)(χ~2=4.197,P=0.040).There was no significant difference in the positive rate of piperacillin antibody between patients with history of blood transfusion(10.99%)and patients without history of blood transfusion(15.65%)(χ~2=0.941,P=0.332).Piperacillin antibody was positive in 24 patients with positive DAT and in 4 patients with negative DAT.The positive rate of piperacillin antibody was higher in patients with positive DAT(26.67%)than that in patients with negative DAT(3.45%)(χ~2=23.262,P<0.001).Conclusions The piperacillin-tazobactam sodium would induce piperacill

关 键 词：血液病 哌拉西林他唑巴坦钠 药物抗体 微柱凝胶法 直接抗球蛋白试验 

分 类 号：R969[医药卫生—药理学]