血药浓度和肾功能对利奈唑胺相关血小板减少的影响

目的：探讨应用利奈唑胺患者的血药浓度和肾功能对该药所致血小板减少的影响。方法：采用前瞻观察性研究，调查2012年8月-2013年8月某院应用利奈唑胺治疗的73例感染住院患者给药后第3、7、12天利奈唑胺的血药浓度。结果：发生利奈唑胺相关血小板减少者21例（28．8％）；3例次（2．1％）血药浓度〈2gg／ml；第3、7、12天血小板减少组的血药浓度均高于血小板未减少组，差异有统计学意义（P〈0．05）；第3、7、12天肾功能不全组患者血药浓度均高于肾功能正常组，差异有统计学意义（P〈0．05）；肾功能不全组与肾功能正常组血小板减少的发生率分别为65．2％（15／23）和12．O％（6／50），差异有统计学意义（P〈0．05）。结论：肾功能不全易导致血药浓度增高，肾功能不全和血药浓度增高可能是诱发血小板减少的危险因素；利奈唑胺血药浓度在不同患者中的个体差异较大，需要通过血药浓度监测制订个体化给药方案。

Effects of Blood Concentration of Linezolid and Renal Function on Linezolid-induced Thrombocytopenia

OBJECTIVE： To explore the effects of blood concentration of linezolid and renal function on linezolid-induced thrombocytopenia in patients who received the drug. METHODS： A prospective observational study was performed between Aug. 2012 and Aug. 2013. 73 patients who received linezolid therapy in a hospital were included. Blood concentrations of linezolid were monitored on 3rd, 7th and 12th day after medication. RESULTS： Linezolid-induced thrombocytopenia occurred in 21 patients （28.8%）. A wide variability among patients was observed, and blood concentration of linezolid was lower than 2 μg/ml in 3 cases （2.1%）. The blood concentrations of linezolid in thrombocytopenia group were higher than non-thrombocytopenia group on 3rd, 7th, 12th day; there was statistical significance （P〈0.05）. The blood concentration of renal dysfunction group was higher than that of normal renal function group on 3rd, 7th, 12th day; there was statistical significance （P〈0.05）. The incidence of thrombocytopenia in renal dysfunction group and normal renal function group were 65.2 % （15/23） and 12.0 % （6/50）, respectively; there was statistical significance （P〈0.05）. CONCLUSIONS： Patients with renal dysfunction are more likely to have a high blood concentration of linezolid. In addition, high blood concentration of linezolid and renal dysfimction significantly affect the development of thrombo- cytopenia. A wide variability among patients was observed. Blood concentration should be monitored in patients in order to decide individual dosage regimen of linezolid in clinical practice.