肝移植术后应用利奈唑胺对血小板的影响

Risk of thrombocytopenia in patients after liver transplantation: comparative analysis of linezolid and vancomycin use in 85 cases after liver transplantation

目的分析肝移植术后应用利奈唑胺的不良反应及对患者预后的影响,评价其发生血小板减少的风险及治疗的有效性和安全性。方法选取2007年9月至2009年6月在本院肝移植中心行肝移植的患者85例,采取随机、对照的方法分为利奈唑胺组和万古霉素组,以治疗前、治疗后第3天、第5天、第7天、治疗结束以及治疗结束后第7天等6个时间点,分别从临床特征、血小板计数、发生血小板减少患者的累计发生率、临床疗效和细菌学检查结果等方面进行对比分析。结果随着用药时间的延长,两组患者平均血小板数量无减少的趋势,利奈唑胺组用药前及治疗结束后血小板计数分别为(71.25±11.01)×109/L和(86.74±11.60)×109/L;万古霉素组用药前及治疗结束后分别为(62.0±19.11)×109/L和(85.2±12.73)×109/L,两组差异无统计学意义;用药前后发生血小板减少的患者累计发生率两组的差异无统计学意义(利奈唑胺组2.3%,万古霉素组2.5%),其中利奈唑胺组45%的患者血小板计数无明显变化或增加,万古霉素组47%的患者血小板计数无明显变化或增加。通过临床疗效及细菌学疗效对比,利奈唑胺组和万古霉素组的有效性差异也无统计学意义。其中临床疗效的有效率分别为90.9%和92.5%,细菌学疗效的有效率分别为91.8%和92.8%。结论与万古霉素相比,在肝移植术后发生革兰阳性球菌的患者中使用利奈唑胺并不会引起血小板的减少,其安全性及有效性与万古霉素相似。

Objective To demonstrate the influence of the linezolid′s adverse events, especially the thrombocytopenia, and compare the safety and efficacy of linezolid and vancomycin in patients after liver transplantation. Method One prospective, randomized, comparative-controlled clinical study was conducted. Eighty-five patients who did the liver transplantation were enrolled between September 2007 and June 2009. Palates counts, cumulative incidence of substantially low platelet counts among patients, two drugs′ efficacy were measured and compared on day 3, day 5, day 7, at the end of treatment, or at follow-up for 44 linezolid and 40 vancomycin recipients. Results There was no relationship between thrombocytopenia and duration of treatment. When prolonged the treatment, the decrease trend with the platelet was not distinct and also has no significant difference between the two groups. Before the therapy and at the end of treatment the platelet counts in linezolid group were （71.25±11.01）×109/L vs （86.74±11.60）×109/L respectively, whereas in vancomycin group there were （62.0±19.11） ×109/L vs （85.2±12.73）×109/L. Percentage of patients treated for ≥5 days who had ≥1 substantially low platelet count during the study was similar between treatment groups, 1（2.3%） of 44 linezolid recipients and 1（2.5%） of 40 vancomycin recipients, whereas one-half of all patients experienced increases or no change of percentage change in platelet count, including 20 linezolid recipients（45%） and 19 vancomycin recipients （47%）. Besides, the efficacy and safety between this two groups didn’t have significant difference. Conclusions Clinically significant thrombocytopenia is uncommon in our analysis, and linezolid is not associated with a greater risk of thrombocytopenia in liver transplantation patients than is vancomycin.