哌拉西林他唑巴坦致药源性血小板减少症的临床特征分析

Analysis of clinical characteristics of DITP induced by piperacillin tazobactam

目的探讨哌拉西林他唑巴坦导致药源性血小板减少症(DITP)的特点,从而避免因DITP导致严重出血不良事件。方法检索中国期刊全文数据库、维普中文科技期刊数据库、万方数据库、PubMed数据库关于哌拉西林他唑巴坦致DITP的病例报道,剔除重复病例报道、综述性文章,共搜集到23例个例报道采用文献计量学方法进行统计分析。结果老年患者(占60.87%)及联合使用氟康唑、氟喹诺酮类抗菌药物患者更易发生DITP;发生时间主要为用药后2~14 d(65.21%);血小板计数减少至10×10 9/L者占47.83%,其中69.57%合并其他症状;停/换药后血小板计数可恢复,给予其他对症处理可使血小板计数恢复时间明显缩短(≤10 d恢复者69.23%vs.100.00%);再次使用哌拉西林他唑巴坦会更快、更严重地诱导DITP的发生。结论临床应重视哌拉西林他唑巴坦导致DITP的可能性,需及时识别并根据病情给予对症处理。

Objective To investigate the characteristics of drug-induced thrombocytopenia(DITP)induced by piperacillin tazobactam,and to avoid serious adverse events caused by DITP.Methods The DITP cases induced by piperacillin tazobactam were retrieved from China National Knowledge Internet,VIP journal database,Wanfang database and PubMed database with elimination of duplicate reports and reviews.A total of 23 case studies were collected,which relevant data was analyzed statistically via bibliometrics.Results DITP was more likely to occur in elderly patients(60.87%)and cases which fluconazole and fluoroquinolone agents combined.DITP occurred mainly 2 to 14 days after medication(65.21%).Platelet count decreased to 10×10 9/L in 47.83%of cases,of which 69.57%accompanied by other symptoms.After stopping piperacillin tazobactam,platelet count could be recovered,and other symptomatic treatment could significantly shorten the recovery time(recovery time≤10 d,69.23%vs.100.00%).Piperacillin tazobactam prescripted again could induce DITP more rapidly and heavily.Conclusion Clinical attention should be paid to the possibility of DITP caused by piperacillin and tazobactam.Timely identification and diagnosis are essential,which should get symptomatic treatment according to the condition.