头孢菌素致药源性血小板减少症35例的文献分析

目的探讨头孢菌素致药源性血小板减少症(DITP)的相关特征。方法通过中国知网、万方、维普3大数据库,检索头孢菌素致DITP个例文献,进行一般情况、感染疾病、头孢菌素种类、用药前后血小板(PLT)变化、骨髓穿刺和凝血检测结果、临床表现、PLT恢复时间、临床转归等内容进行统计分析。对首次发现DITP的PLT计数和停药前的PLT计数进行对比分析。结果30篇文献35例患者,男女之比为2:1,年龄均值(57.9±25.2)岁。涉及头孢菌素类药品14种,其中头孢哌酮类占48.6%。临床表现,无症状为51.4%,出血表现为48.6%。首次发现DITP时间为2min~11d间,其中≤1d、2d~4d、5d~7d和≥8d分别为39.4%、21.2%、27.3%和18.2%。首次检测停药为57.1%、第2次检测停药为37.1%、第3次检测停药为5.7%。首次发现DITP和停药前PLT计数的降低程度和检测值,均存在显著性差异(X²=8.231、P=0.004,t=3.878、P=0.000)。PLT恢复率97.1%、临床病死率2.9%。结论临床对头孢菌素所致的DITP普遍认识不足,早期识别DITP,对改善患者的预后具有重要的临床意义。

Comprehensive Analysis on Drug-induced Thrombocytopenia of 35 Cases With Cephalosporin

Objective To discuss the clinical characteristics of drug-induced thrombocytopenia(DITP)caused by cephalosporins.Methods Through CNKI,Wanfang and VIP databases,we searched the literature of individual cases of DITP caused by cephalosporin,and analyzed the general situation,infectious diseases,cephalosporin types,platelet(PLT)changes before and after treatment,bone marrow puncture and coagulation test results,clinical manifestations,PLT recovery time,clinical outcomes,etc.A comparative analysis was performed for PLT count at first discovery of ditp and PLT count before discontinuation.Results Thirty five patients from 30 literatures with male to female ratio of 2:1 and mean age(57.9±25.2)years were included.Fourteen types of cephalosporins were involved,among which cefoperazone type accounted for 48.6%.Clinical manifestations,asymptomatic is 51.4%,bleeding is 48.6%.The first time of DITP was 2min~11d,among which≤1d,2d~4d,5d~7d and≥8d were 39.4%,21.2%,27.3% and 18.2%,respectively.The rate of discontinuation in the first test was 57.1%,the rate of discontinuation in the second test was 37.1%,and the rate of discontinuation in the third test was 5.7%.It was found for the first time that there were significant differences in the degree and detection value of DITP and PLT before discontinuation(X²=8.231,P=0.004;t=3.878,P=0.000).The recovery rate of PLT was 97.1% and the mortality rate was 2.9%.Conclusion The clinical recognization of DITP caused by cephalosporin is generally insufficient.Early recognition of DITP had important clinical significance in improving the prognosis of patients.