替加环素致老年患者低纤维蛋白原血症危险因素分析及预测模型建立  

Risk factor analysis of tigecycline-induced hypofibrinogenemia in elderly patients and the establishment of its prediciton model

作　　者：秦艳 周怡佳 沈赟 陈喆 叶岩荣 邹烨 QIN Yan;ZHOU Yijia;SHEN Yun;CHEN Zhe;YE Yanrong;ZOU Ye(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;School of Pharmacy,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]复旦大学附属中山医院药剂科,上海200032 [2]上海健康医学院药学院,上海201318

出　　处：《药学前沿》2025年第2期277-283,共7页China Pharmacist

基　　金：上海市临床重点专科项目(shslczdzk06504)。

摘　　要：目的分析老年患者应用替加环素后发生相关低纤维蛋白原血症的危险因素,并建立替加环素致低纤维蛋白原血症的列线图模型。方法回顾性收集复旦大学附属中山医院2022年1月至2023年12月接受替加环素治疗的老年患者的临床资料。根据用药后患者是否发生低纤维蛋白原血症分为低纤维蛋白原血症组和正常纤维蛋白原组。采用单因素分析和多因素Logistic回归分析老年患者应用替加环素期间发生低纤维蛋白原血症的独立危险因素,并构建列线图模型,评估不良反应的发生风险。结果研究共纳入261例老年患者,其中136例(52.1%)发生低纤维蛋白原血症。单因素分析结果显示,体重、用药天数、给药剂量、基线纤维蛋白原、红细胞计数、血红蛋白以及联用糖肽类药物是危险因素(P<0.05)。多因素Logistic回归分析显示,基线纤维蛋白原、用药天数与给药剂量均为老年患者发生低纤维蛋白原血症的独立危险因素(P<0.05)。列线图模型受试者工作特征曲线下面积(95%CI)为0.7748(0.712,0.827),灵敏度与特异度分别为66.67%和82.22%,校准曲线的平均绝对误差为0.039,Hosmer-Lemeshow拟合优度检验显示,风险预测值与实测值差异无统计学意义。结论替加环素致老年患者低纤维蛋白原血症的独立危险因素为基线纤维蛋白原、用药天数、给药剂量;在此基础上建立的列线图模型对于评估不良反应的发生具有较好的预测价值。Objective To analyze the risk factors of tigecycline induced hypofibrinogenemia in elderly patients,and establish a nomogram model of tigecycline-induced hypofibrinogenemia.Methods Clinical data of elderly patients treated with tigacycline were retrospectively collected from Zhongshan Hospital,Fudan University from January 2022 to December 2023.Patients were divided into hypofibrinogenemia group and non-fibrinogenemia group according to whether they developed hypofibrinogenemia after treatment.Univariate analysis and multivariate Logistic regression analysis were used to analyze the independent risk factors for hypofibrinogenemia in elderly patients during tigecycline application,and a nomogram model was constructed to evaluate the risks of adverse reactions.Results A total of 261 elderly patients were included in the study,and 136(52.1%)had hypofibrinogenemia.The results of univariate analysis showed that weight,days of medication,dosage,baseline fibrinogen,red blood cell count,hemoglobin and combination with glycopeptides were risk factors(P<0.05).Multivariate Logistic regression analysis showed that baseline fibrinogen,days of medication and dosage were all independent risk factors for hypofibrinogenemia in elderly patients(P<0.05).The area under the receiver operating characteristic curve(95%CI)of the nomogram model was 0.7748(0.712,0.827),the sensitivity and specificity were 66.67% and 82.22%,respectively.The average absolute error of calibration curve was 0.039,and the Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted risk value and the measured value.Conclusion The baseline fibrinogen,days of medication,dosage are independent risk factors of tigecycline induced hypofibrinogenemia in elderly patients.The nomogram model established on this basis shows good predictive value for assessing the occurrence of adverse reactions.

关 键 词：替加环素 低纤维蛋白原血症 危险因素 列线图 老年人 LOGISTIC回归 不良反应 受试者工作特征曲线 

分 类 号：R969.3[医药卫生—药理学]