成人危重症患者利奈唑胺相关性血小板减少症的危险因素分析

目的:了解ICU危重症患者使用利奈唑胺治疗后并发血小板减少症的情况,并进行相关危险因素分析,为临床的合理安全用药提供依据。方法:采用回顾性研究方法,选取广州市某三甲医院ICU病房2013年1月-2014年12月使用利奈唑胺注射剂或片剂的成人患者病例,调查利奈唑胺治疗中并发血小板减少症的情况,并用单因素和多因素逐步Logistic回归分析其相关危险因素。结果:通过统一的纳入和排除标准筛选符合要求的病例共57例,利奈唑胺治疗中并发血小板减少症的发生率为28.07%,并发血小板减少组与未并发组相比,血小板基线值较低(174.06±53.21)×10⁹/L:(228.93±81.86)×10⁹/L,P=0.019],APACHEⅡ评分较高(22.12±8.66):(16.20±4.77),P=0.039],血清肌酐清除率(Ccr)较低(中位数41.86,四分位数间距26.26):(中位数71.84,四分位数间距56.40),P=0.003];多因素逐步Logistic回归显示利奈唑胺治疗中并发血小板减少症的危险因素包括血小板基线值(OR 5.02,95%CI 1.01~17.95,P=0.043),CCr(OR 5.16,95%CI 1.21~22.03,P=0.027)和APACHEⅡ评分(OR 3.92,95%CI 1.08~14.14,P=0.037)。结论:危重症患者在使用利奈唑胺治疗的过程中应警惕血小板减少症的发生,尤其是血小板基线值<200×10⁹/L、肾功能不全(Ccr<50 mL·min^-1)和APACHE Ⅱ≥20分的患者。

Risk factors for linezolid-associated thrombocytopenia in critically ill adult patients

OBJECTIVE To investigate prevalence and associated risk factors of thrombocytopenia (TP) induced by linezolid (LZD) in critically ill adult patients,and provide a reference for rational use of linezolid. METHODS A retrospective study was performed in critically ill patients treated with LZD injection or tablets between January 2013 and December 2014 at a tertiary hospital in Guangzhou.Prevalence and risk factors for LZD-associated TP were investigated and identified via univariate and multivariate logistic regression analyses. RESULTS A total of 57 cases were screened out according to inclusion and exclusion criteria,and prevalence of LZD induced TP was 28.07%.Compared to patients without TP,patients with TP had lower baseline platelet count (174.06±53.21)×10⁹/L:(228.93±81.86)×10⁹/L,P=0.019], higher APACHE Ⅱ scores(22.12±8.66):(16.20±4.77), P=0.039] and lower ceatinine clearance (Ccr)(median 41.86,interquartile range 26.26):(median 71.84,interquartile range 56.40), P=0.003]. Multivariate logistic regression analysis showed that baseline platelet count (OR 5.02,95%CI 1.01-17.95,P=0.043),Ccr (OR 5.16,95%CI 1.21-22.03,P=0.027) and APACHE Ⅱ score (OR 3.92, 95%CI 1.08-14.14,P=0.037) were significant risk factors for LZD induced TP. CONCLUSION Critically ill patients should be closely monitored for TP during LZD therapy, especially in those with baseline platelet count <200×10⁹/L,renal insufficiency (Ccr<50 mL·min^-1) and APACHE Ⅱ score≥20.