利奈唑胺对高龄老年人血液系统的影响

Hematologic effects of linezolid in advanced aged patients

目的 评价利奈唑胺对高龄住院感染患者血液系统的影响. 方法 回顾性分析利奈唑胺治疗45例高龄感染患者的临床资料和血常规检查结果. 结果 使用利奈唑胺治疗的45例患者中,出现血小板显著降低者20例（44.4％）,血红蛋白显著降低者6例（13.3％）,中性粒细胞显著降低者1例（2.2％）,因血液系统不良反应停药19例.血小板显著降低出现时间为用药后5～17 d,平均（10.2±3.3）d；血红蛋白显著降低出现时间为用药后6～14 d,平均（9.8±3.0）d；血小板及血红蛋白的最低值分别出现在用药后（13.1±3.9）d及（10.5±3.5）d,部分患者的血小板及血红蛋白下降可出现在停药后.多因素回归分析显示治疗时间和肌酐清除率是血小板降低相关的危险因素（OR=1.407,0.732,P＜0.05）. 结论 高龄老年人使用利奈唑胺时易发生血液系统不良反应,主要表现为血小板显著减少,尤其易发生在肾功能不全和用药时间延长的患者,高龄老年人在使用该药时应密切监测血常规变化.

Objective To evaluate the hematologic effects of linezolid in advanced aged patients with hospital onset of infection.Methods The clinical characteristics and complete blood routine examination results of 45 elderly patients aged（92.9±5.2）years treated with linezolid over 600 mg of lowest dose everyday for more than 72 hours were retrospectively analyzed.Results Among the 45patients,20 patients（44.4%）had substantially lower platelet,6 patients（13.3%）lower haemoglobin,1 patient（2.2%）lower absolute neutrophil,and the linezolid treatment in 19 patients were discontinued due to hematological system adverse reactions.The significant drop in platelet occurred at（10.2±3.3）days after treatment.The significant drop in hemoglobin occurred at（9.8±3.0）d after treatment.The lowest count of platelet and hemoglobin took place at（13.1±3.9）d and （10.5±3.5）d after treatment,respectively.The drops in platelet and hemoglobin of some patients took place after cease of treatment.Stepwise logistic regression analysis revealed that treatment duration（OR =1.407,P〈0.05）and creatinine clearance rate（OR=0.732,P〈0.05）were the risk factors for thrombocytopenia.Conclusions The elderly patients using linezolid more likely suffer from adverse reactions of hematological system,particularly thrombocytopeniawhich is significantly more common in patients with renal insufficiency and prolongation of treatment time.The blood routine examination should be monitored closely when elderly patients are treated with linezolid.