替加环素对重症急性胰腺炎患者肝功能、淀粉酶及凝血功能的影响

Influence of Tigecycline on the Liver Function,Amylase and Coagulation of Patients with Severe Acute Pancreatitis

目的:分析替加环素对重症急性胰腺炎患者肝功能、淀粉酶及凝血功能的影响,为合理使用替加环素提供参考。方法:回顾性选择某院2017年6月至2019年5月期间使用替加环素治疗的重症急性胰腺炎患者,共纳入51例。根据用药前总胆红素(TBIL)、直接胆红素(DBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、淀粉酶(AMY)、纤维蛋白原(FBG)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)等指标值分为正常组和异常组,观察使用替加环素后两组肝功能、淀粉酶及凝血功能的变化。另外,根据替加环素用量不同,分为高剂量组和标准剂量组,比较两个剂量组发生不良反应的差异。结果:使用替加环素后,异常组TBIL、DBIL、AST指标值升高的发生比例高于正常组,异常组ALT、ALP指标值升高的发生比例低于正常组;正常组有1例AMY出现指标值升高,用药14 d恢复正常,而异常组未见升高;异常组PT、APTT指标升高的发生比例高于正常组,异常组FBG指标降低的发生比例高于正常组。标准剂量组和高剂量组发生肝功能异常、AMY升高的例次差异无统计学意义(P=0.43和P=0.36)。而高剂量组发生PT和APTT延长的例次显著高于标准剂量组(P=0.02和P=0.01),但两组FBG降低的发生例次差异无统计学意义(P=0.26)。结论:应用替加环素应关注肝功能异常、凝血功能异常的发生,尤其是用药前肝功能、凝血功能异常的患者。而高剂量替加环素可能增加PT和APTT延长的发生率。

Objective:To analyze the effect on liver function,amylase and coagulation function,so as to provide clinical reference for rational use of tigecycline.Methods:Patients with severe acute pancreatitis treated with tegacyclin in the one hospital from June 2017 to May 2019 were retrospectively selected.A total of 51 patients were enrolled according to the classification criteria.Divided into normal group and abnormal group according to the index values of TBIL,DBIL,ALT,AST,AMY,PT,APTT,FBG etc.Before medication,and observed the changes of liver function,amylase and blood coagulation function in the two groups after using tigecycline.In addition,according to the different dosage of tigecycline,they were divided into high-dose group and standard-dose group.The adverse reactions of the two groups of patients were compared.Results:After tigecycline was injected,the proportion of increased TBIL,DBIL and AST indices in abnormal group were higher than that in normal group,while the proportion of increased ALT and ALP indices in abnormal group were lower than that in normal group.One case in the normal AMY group showed an increase in the index value,which returned to normal after 14 days medicating,while no increase was observed in the abnormal group.The proportion of increased PT and APTT index in abnormal group were higher than that in normal group,and the proportion of decreased FBG index in abnormal group were higher than that in normal group.No significant difference was found between the standard dose group and the high-dose group in the abnormal liver functionand the increase of AMY(P=0.43 and P=0.36).The number of prolonged PT and APTT in the high-dose group was significantly higher than that in the standard-dose group(P=0.02 and P=0.01),but there was no significant difference in the number of FBG reduction between the two groups(P=0.26).Conclusion:Special attention should be paid to the abnormal liver function and the abnormal coagulation function when using tigecycline,especially for patients with abnormal liver function and coagulation function before medication.High-dose tigecycline may increase the incidence of prolonged PT and APTT.