替加环素相关低纤维蛋白原血症在重症患者中的临床特点及危险因素分析  

Analysis on clinical characteristics and risk factors of tigecycline-associated hypofibrinogenemia in critically ill patients

作　　者：陆瑾[1] 展冠军[2] 徐家兵[1] 蒙钟经 李妮妮 刘中秋 胡琳璘 Lu Jin;Zhan Guanjun;Xu Jiabing;Meng Zhongjing;Li Nini;Liu Zhongqiu;Hu Linlin(Department of Pharmacy,Jiangbei District of Zhongda Hospital Affiliated to Southeast University,Nanjing 210048,China;Department of Pharmacy,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院江北院区药学部,南京210048 [2]东南大学附属中大医院药学部,南京210009

出　　处：《药物不良反应杂志》2024年第10期608-614,共7页Adverse Drug Reactions Journal

基　　金：南京药学会常州四药医院药学科研基金(2023YX014);江苏省药学会-石药医院药学科研基金(SY202306-1)。

摘　　要：目的:探讨替加环素相关低纤维蛋白原血症在重症患者中的临床特点并分析其发生的危险因素。方法:收集2021年1月至2022年12月在东南大学附属中大医院重症医学科住院期间使用替加环素治疗患者的临床资料并进行回顾性分析。根据血浆纤维蛋白原(FIB)水平将患者分为低纤维蛋白原血症组及无低纤维蛋白原血症组,比较2组患者一般资料,实验室检查结果、替加环素用药情况、合并用药情况,以及替加环素血药浓度等临床特点;将组间比较中P<0.10的变量纳入多因素logistic回归方程,分析替加环素相关低纤维蛋白原血症的危险因素,计算比值比(OR)及其95%置信区间(CI)。结果:共收集到使用替加环素的患者79例,发生低纤维蛋白原血症者43例(54.4%),无低纤维蛋白原血症者36例。单因素分析结果显示,有糖尿病[41.9%(18/43)比16.7%(6/36)]、存在急性肾损伤[41.9%(18/43)比19.4%(15/36)]、基线(使用替加环素前)FIB≤4 g/L[37.2%(16/43)比16.7%(6/36)]2组间比较差异有统计学意义(P<0.05)。将2组P<0.10的相关因素有糖尿病、存在急性肾损伤、行连续肾脏替代疗法、基础(使用替加环素前)FIB≤4 g/L、替加环素总剂量较大与总疗程较长纳入多因素logistic回归分析,结果显示,糖尿病(OR=4.851,95%CI:1.180~19.494,P=0.029)、连续肾脏替代疗法(OR=8.610,95%CI:1.987~37.311,P=0.004)、长疗程(OR=1.452,95%CI:1.018~2.071,P=0.040)是发生替加环素相关低纤维蛋白原血症的独立危险因素。结论:重症患者中,糖尿病、连续肾脏替代疗法及长疗程使用替加环素可能增加低纤维蛋白原血症的发生风险。Objective To explore the clinical characteristics of tigecycline-associated hypofibri-nogenemia in critically ill patients,and analyze risk factors for its occurrence.Methods Clinical data of patients treated with tigecycline in the Intensive Care Unit(ICU)at Zhongda Hospital Affiliated to South-east University from January 2021 to December 2022 were collected and retrospectively analyzed.Patients were divided into hypofibrinogenemia group and non-hypofibrinogenemia group according to their fibrinogen levels.General information,laboratory tests results,tigecycline application,combined drugs,and blood concentration of tigecycline were compared between the 2 groups.Variables with P<0.10 in intergroup comparisons were included in a multivariate logistic regression model to analyze the risk factors for tigecy-cline-associated hypofibrinogenemia,and odds ratios(OR)and its 95%confidence intervals(CI)were calcu-lated.Results A total of 79 patients using tigecycline were collected,including 43 cases with hypofibrin-ogenemia and 36 cases without hypofibrinogenemia.Univariate analysis showed that the differences in patients with diabetes[41.9%(18/43)vs.16.7%(6/36)],acute kidney injury[41.9%(18/43)vs.19.4%(15/36)],and baseline fibrinogen(before tigecycline treatment)≤4 g/L[37.2%(16/43)vs.16.7%(6/36)]between the 2 groups were statistically significant(all P<0.05).The related factors(P<0.10)of the 2 groups,including diabetes,acute renal injury,continuous renal replacement therapy,baseline FIB≤4 g/L(before using tigecy-cline),larger total dose of tegacycline and longer treatment duration,were included in the multivariate logistic regression analysis.The results showed that diabetes(OR=4.851,95%CI:1.180-19.494,P=0.029),continuous renal replacement therapy(OR=8.610,95%CI:1.987-37.311,P=0.004),and longer treatment duration(OR=1.452,95%CI:1.018-2.071,P=0.040)were independent risk factors for tigecycline-related hypofibrinogenemia.Conclusion In critically ill patients,with diabetes,continuous renal replacement therapy,and longe

关 键 词：替加环素 重症监护病房 低纤维蛋白原血症 危险因素 临床特点 

分 类 号：R969.3[医药卫生—药理学]