利奈唑胺相关性血液毒性的危险因素分析

Risk Factors of Linezolid-related Hematologic Toxicity

关键词:  利奈唑胺  血液毒性  白细胞减少症  血小板减少症  危险因素

Key words:  linezolid  hematologic toxicity  leukopenia  thrombocytopenia  risk factor

摘要:

目的 探讨接受利奈唑胺治疗住院患者发生相关性血液毒性的危险因素。方法 采用单中心、观察性、回顾性研究。收集78例接受利奈唑胺治疗且监测血药浓度的住院患者的临床资料，多因素Logistic回归分析其相关危险因素。结果 Logistic回归分析显示利奈唑胺疗程[OR=1.296（1.094~1.53），P=0.003]，肾小球滤过率估计值<30 mL·min^-1·（1.73 m²）^-1[OR=11.582（1.870~71.729），P=0.008]是白细胞减少症的显著危险因素；利奈唑胺首次谷浓度[OR=1.178（1.052~1.318），P=0.005]，基础血白蛋白值< 30 g·L^-1[OR=4.175（1.315~13.254），P=0.015]是血小板减少症的显著危险因素。结论 利奈唑胺相关性白细胞减少症呈时间依赖，相关性血小板减少症呈浓度依赖，患者在治疗期间应密切监测血常规，情况许可下建议监测血药浓度，行个体化治疗。

Abstract:

OBJECTIVE To investigate the risk factors of linezolid-related hematologic toxicity in hospital patients.METHODS In this single center, observational retrospective study, main clinical characteristics of 78 inpatients undergoing therapeutic drug monitoring during linezolid therapy were reviewed. The risk factors of linezolid-related hematologic toxicity were confirmed by multivariate Logistic regression analyses.RESULTS In logistic regression analyses, the significant risk factors of linezolid-related leukopenia including duration of linezolid therapy[OR=1.296(1.094-1.53), P=0.003], estimated glomerular filtration rate <30 mL·min^-1·(1.73 m²)^-1[OR=11.582(1.870-71.729), P=0.008]; the first trough concentration of linezolid[OR=1.178(1.052-1.318), P=0.005], baseline serum albumin <30 g·L^-1[OR=4.175(1.315-13.254), P=0.015] were found to be significant risk factors for linezolid-related thrombocytopenia.CONCLUSION Leukopenia is a time-dependent toxicity with linezolid, thrombocytopenia is a concentration-dependent toxicity. Patients should be closely monitored for blood routine throughout linezolid treatment. Therapeutic drug monitoring and individualized therapy may be recommended, if condition permits.