替加环素致重症感染患者低纤维蛋白原血症的回顾性分析

Retrospective Analysis of Hypofibrinogenemia Induced by Tigecycline in Patients with Severe Infection

目的:分析替加环素所致低纤维蛋白原血症的特点,为临床安全合理用药提供依据。方法:利用药品不良反应智能监测系统筛选2020年6月~2022年6月在本院应用替加环素治疗的重症感染患者,根据是否发生低纤维蛋白原血症将其分为降低组和正常组,统计患者性别、年龄、身高、体重、感染部位、微生物检查结果、抗感染治疗方案、用药前后纤维蛋白原、肝肾功能、不良反应发生时机及转归等,采用二元Logistic回归分析出现低纤维蛋白原血症的危险因素。结果:共纳入104例,其中降低组79例,正常组25例,低纤维蛋白原血症的发生率为75.96%。相关性分析发现,替加环素用药疗程、FIB基线值和腹腔感染是重症感染患者导致低纤维蛋白原血症的影响因素。34例(43.04%)在替加环素使用4~6天后发生低纤维蛋白原血症,FIB下降中位时间是第5天。结论:重症感染患者使用替加环素致低纤维蛋白原血症较为常见,与用药疗程、FIB基线值和腹腔感染有关,尤其对低FIB基线值及腹腔感染的患者应积极监测纤维蛋白原指标,加强疗效评估,缩短替加环素用药疗程。

Objective:To analyze the characteristics of hypofibrinogenemia induced by tigecycline,and to provide a base for clinical safe and rational drug use.Methods:The intelligent monitoring system for adverse drug reactions was used to screen patients with severe infection who were treated with tigecycline in our hospital from June 2020 to June 2022.According to whether hypofibrinogenemia occurred,they were divided into reduced or normal groups.The gender,age,height,weight,infection sites,microbiological examination results,anti-infective treatment plans,fibrinogen before and after treatment,liver and kidney functions timing of adverse reactions and outcomes were counted and analyzed for risk factors of fibrinogenemia through binary logistic regression.Results:A total of 104 patients were enrolled,including79 in the reduction group and 25 in the normal group,and the incidence of hypofibrinogenemia was75.96%.Correlation analysis revealed that the duration of tigecycline treatment,baseline FIB value and intra-abdominal infection were influencing factors of hypofibrinogenemia in patients with severe infection.Thirty-four patients(43.04%)developed hypofibrinogenemia 4-6 days after tigecycline treatment,and the median time for FIB to decline was day 5.Conclusion:Hypofibrinogenemia is common in patients with severe infection treated with tigecycline,which is related to the duration of treatment,baseline FIB value and intra-abdominal infection.Especially for patients with low baseline FIB values and intra-abdominal infection,fibrinogen should be actively monitored with strengthened efficacy evaluation and shortened course of treatment.