万古霉素致血小板减少症的研究进展

Research progress in vancomycin-induced thrombocytopenia

血小板减少症是万古霉素严重的不良反应,可致患者出血,危及生命.万古霉素致血小板减少症（VIT）的发生机制尚不明确,多数研究认为与万古霉素依赖性抗血小板抗体IgG和IgM有关.体外研究发现,万古霉素可诱发人血小板发生一系列变化,导致血小板被激活和凋亡.VIT临床表现为不同程度的出血.排除其他疾病和药物因素后诊断为VIT者,应及时停药或换药,严重者可输注血小板,给予糖皮质激素、免疫球蛋白、利妥昔单抗,或进行血液透析.

Thrombocytopenia is a severe adverse reaction of vancomycin, which can cause hemorrhagic death.The pathogenesis of vancomycin induced thrombocytopenia （VIT） is not clear, and most studies suggest that VIT is related to vancomycin-dependent antiplatelet antibodies IgG and IgM.In vitro studies, it was found that vancomycin induced a series of changes in human platelets, resulting in activation, apoptosis, and reduction of platelets.Clinical manifestations of VIT are various degrees of bleeding.If patient was diagnosed with VIT after ruling out the influencing factors of other diseases or drugs, drug treatment should be promptly withdrawn or changed, and in severe cases, platelets transfusion, corticosteroids, immunoglobulins, rituximab, and hemodialysis should be considered.