替加环素对患者凝血指标影响的临床研究

Effect of tigecycline on coagulation markers: a retrospective study

目的分析替加环素对感染患者凝血指标的影响,并筛选出凝血指标异常的危险因素。方法利用医院信息系统及美康合理用药监测系统筛选出2016年1月至2017年12月入我院治疗,并使用替加环素的病例,观察使用替加环素后是否发生凝血指标异常,并比较用药前后纤维蛋白原(FBG)、凝血酶原时间(PT)、部分激活凝血酶原时间(APTT)、凝血酶时间(TT)、血小板(PLT)、丙氨酸氨基转移酶(ALT),血清总胆红素(TBIL)、肾小球滤过率(eGFR)水平的差异。再根据患者是否发生凝血指标异常,利用二分类Logistic回归筛选替加环素导致凝血指标异常的危险因素。结果共纳入97例合格病例进行分析,其中男性69例(71.1%),女性28例(28.9%);年龄(56.93±19.31)岁。使用替加环素后,患者FBG水平显著降低(P<0.05);PT、APTT、TT明显延长(P<0.05);PLT水平无明显改变。同时患者ALT、TBIL水平用药前后无明显差异;C反应蛋白(CRP)、降钙素原(PCT)用药后较用药前差异有统计学意义(P<0.05),WBC用药前后无统计学差异,总体WBC、CRP、PCT用药后低于用药前,患者感染状态较用药前改善;eGFR值用药前后差异有统计学意义(P<0.05),用药后患者肾功能好转。Logistic分析发现,高剂量使用替加环素是发生凝血指标异常的危险因素(P<0.05,OR=3.96)。结论替加环素可引起FBG下降,PT、APTT、TT延长,且高剂量使用的患者更易发生该不良事件。

Objective To determine the effect of tigecyclin on coagulation markers in the patients taking it,and screen out the related risk factors.Methods A retrospective study was carried out on the patients with tigecycline treatment admitted to our hospital from January 2016 to December 2017 based on our hospital information system and the Meikang rational drug use monitoring system.Fibrinogen(FBG)level,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),platelet(PLT)count,glomerular filtration rate(eGFR),and levels of alanine aminotransferase(ALT)and serum total bilirubin(TBIL)were compared before and after tigecycline administration.Finally,according to whether patients had abnormal coagulation indicators,Logistic regression was used to screen out high-risk factors of abnormal coagulation indexes caused by tigecycline.Results A total of 97 qualified cases were included in this study,including 69 males(71.1%)and 28 females(28.9%),at a mean age of 56.93±19.31 years.Tigecycline treatment resulted in significantly decreased FBG level(P<0.05)and prolonged PT,APTT and TT(P<0.05),but no such change was seen in PLT count.At the same time,there were no significant differences in ALT and TBIL levels before and after administration,and CRP and PCT showed significant differences(P<0.05),while WBC count showed no significant difference.The total WBC count,and CRP and PCT levels were decreased after administration,indicating the patients’infection status was improved.The eGFR value was remarkably improved(P<0.05),indicating better renal function.Logistic analysis showed that high dose of tigecycline was a risk factor for coagulopathy(P<0.05,OR=3.96).Conclusion Tigecycline may cause decreased FBG,prolonged PT,APTT and TT,and the patients taking high dose tigecycline are prone to this adverse event.