替加环素致低纤维蛋白原血症的危险因素的系统评价

Risk factors for tigecycline-induced hypofibrinogenaemia:a systematic review

目的 探讨替加环素致低纤维蛋白原血症的危险因素,为临床用药提供参考。方法 计算机检索英文数据库(PubMed、Cochrane Library、Embase、Web of Science)及中文数据库(中国期刊全文数据库、万方数据库、维普网及中国生物医学文献数据库)中有关替加环素致低纤维蛋白原血症危险因素的研究文献,检索时限为建库起至2022年2月5日,同时补充搜索未公开发表的临床试验数据。采用卡斯尔-渥太华量表(NOS)对纳入的文献进行质量评价,对符合纳入标准的文献进行数据提取,并采用RevMan5.3软件进行Meta分析或敏感性分析。结果 最终入选8篇文献,中英文文献各4篇,均为病例对照研究,发表时限为2017-2021年,共涉及患者1 374例,其中试验组、对照组分别有706、668例。Meta分析结果显示,替加环素致低纤维蛋白原血症的可能危险因素为:年龄[OR=1.04,95%CI(1.02,1.06),P=0.000 5]、基线纤维蛋白原水平[OR=0.54,95%CI(0.42,0.69),P<0.000 01)]、腹腔感染(敏感性分析)[OR=9.43,95%CI(4.24,20.95),P<0.000 01]、单次给药剂量[OR=2.87,95%CI(2.04,4.02),P<0.000 01]、用药时间[OR=1.10,95%CI(1.00,1.22),P=0.04]。结论 高龄、低基线纤维蛋白原水平、腹腔感染、单次给药剂量偏高、用药时间偏长是替加环素致低纤维蛋白原血症的可能危险因素,患者若存在上述危险因素时,建议替加环素在用药过程中密切关注低纤维蛋白原血症的发生。

OBJECTIVE To investigate the risk factors for tigecycline-induced hypofibrinogenaemia by systematic review.METHODS The literature about risk factors for tigecycline-induced hypofibrinogenaemia were retrieved from English databases(PubMed,Cochrane Library,Embase,Web of Science)and Chinese databases(CNKI,Wanfang Database,VIP,CBM)during the inception to Feb.5th,2022.At the same time,the unpublished clinical trial data were additionally searched.After the quality evaluation of the included literature was carried out by adopting the Castle-Ottawa Scale(NOS),data were extracted from the literature that met the inclusion criteria,and Meta-analysis was conducted by using RevMan 5.3 software.RESULTS Finally,8literature were selected,with a total of 1 374 cases,including 706 cases in the trial group and 668 cases in the control group.There were 4 Chinese and 4 English literature,all of which were case control studies published between 2017-2021.Meta-analysis showed that the risk factors for tigecycline-induced hypofibrinogenaemia were age [OR=1.04,95%CI(1.02,1.06),P=0.000 5],baseline fibrinogen level [OR=0.54,95%CI(0.42,0.69),P<0.000 01],abdominal infection(sensitivity analysis)[OR=9.43,95%CI(4.24,20.95),P<0.000 01],dose each time [OR=2.87,95%CI(2.04,4.02),P<0.000 01],medication time [OR=1.10,95%CI(1.00,1.22),P=0.04].CONCLUSIONS Advanced age,low baseline fibrinogen levels,abdominal cavity infection,relative high dose each time and slightly long medication time are potential risk factors for tigecycline-induced hypofibrinogenaemia.If the above risk factors exist,it is suggested to pay close attention to the occurrence of hypofibrinogenaemia in the course of tigecycline administration.