粒细胞集落刺激因子和替考拉宁治疗恶性血液病的调查

Investigation of granulocyte colony-stimulating factor and teicoplanin in the treatment of haematological malignancy

目的为恶性血液病患者合理地使用重组人粒细胞刺激因子(rhG-CSF)及制定个体化的替考拉宁抗感染方案提供参考。方法调查该院血液病患者的病原菌分布、rhG-CSF及替考拉宁的使用情况,用HPLC法监测替考拉宁血浆谷质量浓度(C min);根据前3 d的平均起始给药剂量(MID)分为2组:MID=533.33 mg·d^-1组及MID<533.33 mg·d^-1组,比较2组替考拉宁的C min值及C min>10 mg·L^-1的概率。结果恶性血液病患者感染G+菌的占比为38.2%;有52.7%的患者发生了Ⅳ度中性粒细胞缺乏;仅有11.8%的患者能够在合理的时机使用rhG-CSF;给予负荷剂量替考拉宁的患者只占48.3%。MID=533.33 mg·d^-1组与MID<533.33 mg·d^-1组相比,MID=533.33 mg·d^-1组患者的替考拉宁C min值在前3 d更高(10.32±5.13 mg·L^-1 vs 5.46±4.65 mg·L^-1,P=0.005),且患者C min的达标率更高(56.3%vs 15.0%,P=0.014)。结论发生Ⅳ度中性粒细胞缺乏的血液病患者需要在正确的时机应用rhG-CSF及给予负荷剂量的替考拉宁,以缩短中性粒细胞缺乏的持续时间并有效控制感染。

Objective To provide reference for haematological malignancy patients for the rational use of recombinant human granulocyte colony-stimulating factor(rhG-CSF)and the individualized teicoplanin dosage regimens.Methods The distribution of pathogens and the use of rhG-CSF and teicoplanin in haematological malignancy patients were investigated.The plasma trough concentration(C min)of teicoplanin was monitored by HPLC.The patients were divided into 2 groups according to the mean initial dose over the first 3 d(MID):MID=533.33 mg·d^-1 group and MID<533.33 mg·d^-1 group.The teicoplanin C min and the probability of C min>10 mg·L^-1 were compared between the 2 groups.Results The proportion of Gram-positive bacteria infection in haematological malignancy patients was 38.2%;52.7%of the patients hadⅣ-degree neutropenia;only 11.8%of the patients were able to use rhG-CSF at a reasonable time,and only 48.3%of the patients were given a loading dose of teicoplanin.Compared with the MID<533.33 mg·d^-1 group,the teicoplanin C min in the MID=533.33 mg·d^-1 group was higher during the first 3 d(10.32±5.13 mg·L^-1 vs 5.46±4.65 mg·L^-1,P=0.005),and the rate of C min>10 mg·L^-1 was also higher in the MID=533.33 mg·d^-1 group(56.3%vs 15.0%,P=0.014).Conclusion Haematological malignancy patients withⅣ-degree neutropenia need to be given rhG-CSF at the right time and given a loading dose of teicoplanin to shorten the duration of neutropenia and control the infection effectively.