重症患者利奈唑胺相关低钠血症危险因素的回顾性分析

Retrospective Analysis of Risk Factors for Linezolid-associated Hyponatremia in Critical Patients

关键词:  利奈唑胺  低钠血症  危险因素  回顾性分析

Key words:  linezolid  hyponatremia  risk factor  retrospective analysis

摘要:

目的 观察利奈唑胺治疗期间低钠血症的发生率，并确定其危险因素。方法 回顾性分析2017年1月—2019年7月浙江中医药大学附属杭州西溪医院重症医学科152例接受利奈唑胺治疗的住院患者。低钠血症定义为利奈唑胺治疗期间血钠含量≤134 mmol·L^-1。通过多元回归分析确定其危险因素。结果 28例（23.3%）患者出现低钠血症，其中2例为严重低钠血症（血纳含量≤128 mmol·L^-1）。单因素和多因素Logistic回归分析表明，应用利奈唑胺前血浆C-反应蛋白（C-reactive protein，CRP）水平（b=0.010，OR=1.019，95%CI 1.005~1.033，P=0.007）以及合并使用脂肪乳氨基酸（18）注射液（b=-1.591，OR=0.151，95%CI 0.034~0.673，P=0.002）是低钠血症发生相关的独立变量。利奈唑胺治疗前，低钠血症组CRP水平显著高于非低钠血症组（t=-2.932，P=0.004）。在联合应用脂肪乳氨基酸（18）注射液的患者中，低钠血症发生的频率明显更高（c²=20.444，P=0.003）。结论 使用利奈唑胺治疗的严重炎症患者和联合使用脂肪乳氨基酸（18）注射液的患者的血浆钠水平应该持续监测。

Abstract:

OBJECTIVE To examine the incidence rate of hyponatremia that developed during linezolid therapy and identify its risk factors. METHODS In this retrospective analysis study, 152 hospitalized patients treated with linezolid in intensive critical unit of Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University between January 2017 and July 2019 were analyzed. Hyponatremia was defined as sodium level ≤ 134 mmol·L^-1 for the duration of linezolid therapy. Its risk factors were identified via a Logistic regression analysis. RESULTS Hyponatremia occurred in 28(23.3%) patients, and among these it was severe in two cases (sodium level ≤ 128 mmol·L^-1). Univariate and multiple Logistic regression analyses identified the plasma C-reactive protein(CRP) level(b=0.010, OR=1.019, 95%CI 1.005-1.033, P=0.007) before the initial administration of linezolid and the concomitant use of a fat emulsion and amino acids(18) injection(β=-1.591, OR=0.151, 95%CI 0.034-0.673, P=0.002) as the independent variables associated with the development of hyponatremia, respectively. Before linezolid treatment, the CRP levels of the hyponatremia group were significantly higher than those of the no-hyponatremia group(t=-2.932, P=0.004). The frequency of hyponatremia development was significantly higher in the patients who received both the fat emulsion and amino acids(18) injection and linezolid (c²=20.444, P=0.003). CONCLUSION These results suggest that the plasma sodium levels of patients with severe inflammation who are treated with linezolid and those of linezolid-treated patients co-administered a fat emulsion and amino acids(18) injection shall be continuously monitored.