万古霉素致白细胞减少症患者白细胞计数恢复正常的影响因素分析  

Influencing Factors of the Recovery of White Blood Cell Count to Normalization in Patients with Leukopenia Induced by Vancomyci

作　　者：赵芳芳[1] 褚燕琦[1] 刘琛[1] 白向荣[1] ZHAO Fangfang;CHU Yanqi;LIU Chen;BAI Xiangrong(Xuanwu Hospital,Capital Medical University·National Clinical Research Center for Geriatric Disorders,Beijing,China 100053)

机构地区：[1]首都医科大学宣武医院·国家老年疾病临床医学研究中心,北京100053

出　　处：《中国药业》2025年第9期113-116,共4页China Pharmaceuticals

基　　金：北京市属医院科研培育计划项目[PX20200805]。

摘　　要：目的为临床安全、合理使用万古霉素提供参考。方法检索国家药品不良反应监测系统2006年1月至2022年12月万古霉素致白细胞减少症的不良反应报告,收集患者性别、年龄、感染类型、白细胞计数、治疗药物、转归等,依据出现白细胞减少症后是否停用万古霉素将患者分为停药组(36例)和未停药组(24例),比较两组患者临床特征及白细胞计数恢复正常的时间。依据白细胞计数是否恢复正常(>4.0×10^(9)/L)将患者分为恢复组(20例)和未恢复组(40例),采用二元Logistic多因素回归分析法分析万古霉素致白细胞减少症患者白细胞计数恢复正常的影响因素。结果60例患者中,男40例,女20例;平均年龄51.13岁;65岁以上患者18例;万古霉素的平均疗程为14.7 d,平均日剂量为1.92 g,平均累积剂量为27.28 g。与停药组比较,未停药组患者的年龄显著更小(P<0.05);颅内感染例数显著更少(P<0.05),骨组织感染、监测万古霉素血药浓度、使用人粒细胞集落刺激因子例数均显著更多(P<0.05);白细胞计数恢复正常时间显著更长(P<0.05)。二元Logistic多因素回归分析结果显示,患者基线白细胞计数与万古霉素致白细胞减少症白细胞计数恢复正常呈正相关[OR=0.004,95%CI(0.000,0.490),P=0.024]。结论接受万古霉素治疗的患者一旦出现白细胞计数减少则应及早停药,严重者可考虑使用人粒细胞集落刺激因子等药物治疗,长期用药者应监测万古霉素的血药浓度,以免发生药品不良反应。Objective To provide a reference for the safe and rational use of vancomycin in the clinic.Methods The National Adverse Drug Reaction Monitoring System was searched to collect adverse drug reaction(ADR)reports of leukopenia induced by vancomycin from January 2006 to December 2022.The patients'gender,age,type of infection,white blood cell count(WBC),treatment drugs,and outcomes were collected.Based on whether vancomycin was withdrawal after the onset of leukopenia,patients were divided into the withdrawal group(36 cases)and the non-withdrawal group(24 cases),and the clinical characteristics and recovery time for WBC to normalization between the two groups were compared.According to whether the WBC has returned to normal(>4.0×10^(9)/L),patients were divided into the recovery group(20 cases)and the unrecovered group(40 cases).Binary Logistic multivariate regression analysis was used to analyze the influencing factors of WBC recovery in patients with leukopenia induced by vancomycin.Results Among the 60 patients,there were 40 males and 20 females;the average age was 51.13 years old;18 patients aged>65;the average course of treatment for vancomycin was 14.7 d,with an average daily dose of 1.92 g and an average cumulative dose of 27.28 g.Compared with those in the withdrawal group,the patients'age was significantly younger in the non-withdrawal group(P<0.05);the cases of intracranial infections were significantly fewer in the non-withdrawal group(P<0.05),while the cases of bone tissue infections,monitoring of vancomycin blood concentration,and use of human granulocyte colony-stimulating factor were significantly more in the non-withdrawal group(P<0.05);the recovery time for WBC to normalization was significantly longer in the non-withdrawal group(P<0.05).The results of binary Logistic multivariate regression analysis showed that the patients'baseline WBC was positively correlated with the recovery of WBC to normalization in patients with leukopenia induced by vancomycin[OR=0.004,95%CI(0.000,0.490),P=0.024].Conclusion

关 键 词：万古霉素 白细胞减少症 白细胞计数 药品不良反应 

分 类 号：R95[医药卫生—药学] R978.1