利奈唑胺致老年患者严重低血糖 乳酸酸中毒全血细胞减少一例并文献复习

Serious hypoglycemia,lactic acidosis and pancytopenia caused by Linezolid in elderly patients:a case report and literature review

目的分析并总结利奈唑胺引起老年患者低血糖、乳酸酸中毒、全血细胞减少严重不良反应的病例,旨在加强临床医生对利奈唑胺不良反应的认识。方法报道1例北京医院呼吸科收治的反复发作性尿路感染(RUTI)的患者,该患者在长疗程、反复使用利奈唑胺治疗过程中出现了严重低血糖、乳酸酸中毒、全血细胞减少的不良反应,同时收集2018年12月以前国内外报道的利奈唑胺引起以上3种严重、少见不良反应的文献,对利奈唑胺引起以上3种严重不良反应的危险因素、临床特点及预后情况进行总结分析。结果联同本例复习2018年12月以前应用利奈唑胺引起乳酸酸中毒、全血细胞减少、严重低血糖不良反应的病例共86例,86例患者男女比例为1.8∶1.0,中位年龄64.5岁,65岁及以上老年患者44例,占51.2%。发生乳酸酸中毒的57例患者合并肝脏、肾脏基础病疾病最多见,共25例(43.9%,25/57)。乳酸酸中毒不良反应发生时间为4 h^109 d,中位数值32 d,血乳酸峰值为2.6~38.1 mmol/L,中位数值13.3 mol/L。全血细胞减少不良反应发生于用药后4 h^120 d,中位数值21 d。低血糖不良反应发生时间为用药8 h^26 d,中位时间为10.3 d,血糖最低值为0.2 mmol/L。86例患者中61例(70.9%)患者好转,51例单纯发生乳酸酸中毒患者中有12例死亡,病死率为23.5%,单纯发生全血细胞减少和低血糖患者在及时停用利奈唑胺和对症治疗后病情均好转。结论临床医师在对老年患者应用利奈唑胺过程中应警惕低血糖、乳酸酸中毒、全血细胞减少的严重不良反应,建议在使用中注意监测血糖、血乳酸和血常规变化规律,避免长疗程使用利奈唑胺,使患者在最大程度上获益。

Objective To analyze and summarize adverse reactions such as hypoglycemia,lactic acidosis and pancytopenia caused by Linezolid in elderly patients,in order to enhance clinicians'awareness of adverse reactions of Linezolid.Methods One case with Linezolid-induced lactic acidosis,pancytopenia and hypoglycemia was reported in a patient receiving long-term and repeated use of Linezolid for recurrent urinary tract infections(RUTI)in Beijing Hospital.National and international literature on the three severe and rare adverse reactions caused by Linezolid before December 2018 was reviewed,and the risk factors,clinical characteristics and prognosis of the three severe adverse reactions caused by Linezolid were summarized and analyzed.Results A total of 86 cases with Linezolid-induced adverse reactions such as hypoglycemia,lactic acidosis and pancytopenia were analyzed.Among them,the ratio of males to females was 1.8∶1.0,the median age was 64.5 years,and 44 cases were over 65 years,accounting for 51.2%.Among the 57 patients with lactic acidosis,25 lactic acidosis cases were combined with liver and kidney diseases,which were the most commonly involved organs(43.9%,25/57).The time of onset for lactic acidosis was 4 h-109 d,with a median value of 32 d,and the peak values of blood lactate were 2.6-38.1 mmol/L,with a median value of 13.3 mol/L.Pancytopenia occurred 4 h-120 days after the treatment,and the median value was 21 days.The time of onset for hypoglycemia was 8 h-26,and the median time was 10.3 days.The lowest value of blood glucose was 0.2 mmol/L.Of the 86 cases,61(70.9%)patients improved,and 12 cases of 51 patients with lactic acidosis died,with a mortality rate of 23.5%.Conclusions Clinicians should be aware of serious adverse reactions including hypoglycemia,lactic acidosis and pancytopenia during Linezolid treatment in elderly patients.It is recommended to monitor changes in blood glucose,blood lactate and blood cell count during Linezolid treatment,and to avoid long-term use of Linezolid,so as to maximize the benefits for patients.