利奈唑胺相关血小板减少的危险因素分析

目的探讨利奈唑胺相关血小板减少的危险因素。方法收集2011年1月至2012年7月在复旦大学附属中山医院因感染应用利奈唑胺的162例住院患者的临床资料并进行回顾性分析,根据用药后是否出现血小板减少,将患者分为血小板减少组和血小板正常组。主要分析指标为患者性别、年龄、体重,应用利奈唑胺前血小板计数、血清肌酐清除率(Ccr)、白蛋白、血红蛋白、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平,应用利奈唑胺的剂量、给药途径和持续时间,以及合并用药情况等。对影响血小板计数的相关变量分别进行t检验、Mann-Whitney U检验和Kruskal-Wallis H检验,对筛选出的危险因素进行逐步Logistic回归统计分析,计算比值比(OR)及95%置信区间(CI)。结果 162例患者中男113例,女49例,年龄19～96岁,平均年龄(57.2±16.1)岁;用药方法均为静脉滴注,600 mg/次,2次/d。应用利奈唑胺的时间为1～46 d,中位时间6 d。血小板正常组115例,血小板减少组47例。47例患者用药后出现血小板减少的中位时间为4.5 d,血小板计数平均为(53±29)×109/L,其中轻、中、重度分别为25、10、12例。逐步Logistic回归分析显示,用药前Ccr<50 ml/min的OR为6.75,95%CI为2.93～15.58,P=0.000;血小板计数<100×109/L的OR为4.54,95%CI为1.53～13.50,P=0.006;应用利奈唑胺时间>14 d的OR为4.00,95%CI为1.40～11.39,P=0.009;用药前AST>75 U/L的OR为2.73,95%CI为1.07～6.99,P=0.036。结论应用利奈唑胺前Ccr、血小板计数低于正常、AST高于正常和应用利奈唑胺时间>14 d可能为利奈唑胺相关血小板减少的危险因素。

Analysis for risk factors of thrombocytopenia associated with linezolid

Objective To investigate the risk factors for linezolid-associated thrombocytopenia.Methods The clinical data of 162 in-patients receiving linezolid for infections in Zhongshan Hospital,Fudan University from January 2011 to July 2012 were collected and retrospectively analyzed.The patients were divided into the thrombocytopenia group and the normal platelet group according to the platelet count after linezolid administration.The main analytic indicators included sex,age,body weight,platelet count,serum creatinine clearance rate（Ccr）,levels of albumin,hemoglobin,alanine aminotransferase（ALT）and aspartate aminotransferase（AST） before linezolid administration,dosage,administration route and duration of linezolid therapy,and the situation of drug combination.The correlated variables which affected platelet count were analyzed by t test,Mann-Whitney U test and Kruskal-Wallis H test,respectively.The selected risk factors were analyzed by stepwise Logistic regression,and the odds ratio（OR） and 95% confidence intervals（CI） were calculated.Results One hundred and sixty-two patients comprised 113 male and 49 female with average age of（57.2±16.1） years.All of them received IV infusion of linezolid 600 mg twice daily.The duration of linezolid therapy was 1-46 days and the median time was 6 days.The platelet normal group comprised 115 cases and the thrombocytopenia group comprised 47 cases.The median time of thrombocytopenia onset in 47 patients was 4.5 days,the average count of platelet was（53±29）×109/L,the cases who developed mild,moderate and severe thrombocytopenia were 25,10 and 12,respectively.Stepwise Logistic regression analysis revealed the following results： before drug administration,the OR and 95% CI for Ccr50 ml/min were 6.75 and 2.93-15.58,P=0.000;the OR and 95% CI for platelet count100×109/L were 4.54 and 1.53-13.50,P=0.006;the OR and 95% CI for AST75 U/L were 2.73 and 1.07-6.99,P=0.036;the OR and 95% CI for duration of linezolid therapy14 days were 4.00 and 1.40-11.39,P=0.009.ConclusionThe Ccr and platelet count below normal,the AST level above normal before linezolid administration and the duration of linezolid therapy over 14 days may be the risk factors for linezolid-associated thrombocytopenia.