脓毒症治疗中利奈唑胺与万古霉素对降钙素原和C反应蛋白影响的差异

Effects of linezolid versus vancomycin on procalcitonin and C-reactive protein in treatment of sepsis

目的比较脓毒症患者使用利奈唑胺与万古霉素对降钙素原(PCT)和C反应蛋白(CRP)水平的影响差异。方法回顾性分析2013年1月-2018年6月使用利奈唑胺或万古霉素治疗的脓毒症患者临床资料及相关实验室数据,应用倾向性评分匹配法对组间混杂因素进行矫正,采用重复测量方差分析法比较用药3 d时,利奈唑胺组与万古霉素组患者PCT和CRP水平较未用药(0 d)变化。结果共纳入474例患者,利奈唑胺组249例,万古霉素组225例。经倾向性评分匹配矫正混杂因素后分析表明,与未用药相比,用药3 d时利奈唑胺组患者PCT水平和CRP水平均显著降低,分别为5.8 μg/L对3.1 μg/ L(P <0.001)和75.1 mg/L对46.8 mg/L(P=0.027),差异均有统计学意义;但万古霉素组患者PCT水平和CRP水平的降低不明显,差异无统计学意义(P>0.05)。另外,在经倾向性评分匹配矫正混杂因素后的179对患者中,利奈唑胺组与万古霉素组患者在生存率和治疗有效率方面的差异不明显,均不具有统计学意义(86.0%对81.6%,P=0.251;46.9%对45.3%,P=0.750)。结论在脓毒症患者中,利奈唑胺使用3 d可显著降低PCT和CRP水平,起效更快,但对于治疗结局,利奈唑胺与万古霉素相比差异无统计学意义。

Objective This study aimed to compare the effects of linezolid and vancomycin on procalcitonin (PCT) and C-reactive protein (CRP) in treatment of sepsis.Methods The laboratory and clinical data of sepsis patients treated with linezolid or vancomycin from January 2013 to June 2018 were retrospectively analyzed.The propensity score matching method was used to correct the confounding factors between groups.Repeated measures analysis of variance was used to compare the changes of PCT and CRP levels 3 days after linezolid or vancomycin treatment with the baseline levels before treatment (day 0).Results A total of 474 sepsis patients (249 treated with linezolid and 225 treated with vancomycin) were enrolled.After adjustment for confounding factors by matching the propensity score,the analysis showed that the PCT (5.8 vs.3.1 μg/L,P<0.001) and CRP (75.1 vs.46.8 mg/L,P=0.027) levels in linezolid group significantly decreased 3 days after treatment compared with the levels on day 0 of treatment.The decrease of PCT and CRP levels in vancomycin group was not statistically significant (P>0.05).In addition,in the 179 pairs of patients whose propensity score was matched and adjusted for confounding factors,the survival rate (86.0% vs 81.6%,P=0.251) and treatment efficacy (46.9% vs 45.3%,P=0.750) did not show significant difference between linezolid and vancomycin treatment groups.Conclusions Linezolid can significantly decrease serum levels of PCT and CRP in sepsis patients 3 days after treatment.Linezolid works more quickly but does not show significantly different treatment efficacy from vancomycin.