替加环素致急性胰腺炎的系统评价

Systematic review of tigecycline-induced acute pancreatitis

目的系统分析替加环素致急性胰腺炎的临床特点,为替加环素安全使用提供依据。方法检索PubMed、Embase、Elsevier、CNKI、WanFang Data和VIP数据库,时间截至2022年4月30日,对纳入所有包含替加环素致急性胰腺炎的病例报道进行统计分析。结果纳入了25篇报道的30例患者,来自8个国家,中位年龄50岁(范围9~87岁)。30例患者使用替加环素治疗的中位时间为9 d(范围3~56 d),出现不良反应症状的中位时间为8 d(范围2~28 d),3例患者再次使用替加环素治疗3~28 d后导致急性胰腺炎复发。不良反应主要临床症状包括恶心、呕吐(67.8%),腹痛腹胀(89.2%),血清淀粉酶和血清脂肪酶中位数分别为539.05 U·L^(-1)(范围102~21000 U·L^(-1))、879 U·L^(-1)(范围156~4089 U·L^(-1)),CT检查中70.8%表现为胰腺局限性或弥漫性肿大、胰周炎性改变,25.0%表现为急性胰腺炎。停用替加环素后症状缓解的中位时间为3 d(范围1~10 d),血清淀粉酶或脂肪酶恢复的中位时间为5 d(范围1~43 d)。结论临床应用替加环素时应警惕其引起的急性胰腺炎,若使用期间患者临床症状表现为恶心呕吐、腹胀腹痛,应监测血清淀粉酶、脂肪酶水平及腹部CT,排查是否引起急性胰腺炎。

Objective To systematicly review and analyze the clinical characteristics of tigecycline-induced acute pancreatitis,and provide a basis for the safe application of tigecycline.Methods Databases of PubMed,Embase,Elsevier,CNKI,WanFang Data and VIP data(from inception to April 30,2022)were searched for case reports published about acute pancreatitis caused by tegacyclin,which were statistically analyzed.Results 25 literatures were included involving 30 patients,from 8 countries,the median age was 50 years(rang 9-87).The median duration of treatment with tigecycline was 9 days(range 3-56 d),the median duration of symptom onset was 8 days(range 2-28 d),and 3 patients developed acute pancreatitis aſter 3-28 days of retreatment with tigecycline.Symptoms included nausea,vomiting(67.8%)and abdominal distension and abdominal pain(89.2%).The median levels of amylase and lipase were 539.05(range 102-21000)U·L^(-1) and 879(range 156-4089)U·L^(-1).Computed tomography(CT)scans showed localized or diffuse enlargement of the pancreas and inflammatory changes around the pancreas in 70.8%of cases and acute pancreatitis in 25.0%of cases.The median duration of recovery of symptoms was 3 days(range 1-10 d),and the time for recovery of amylase and lipase to the normal range was 5 days(range 1-43 d)after the withdrawal of tigecycline in all patients.Conclusion Clinicians should be alert to the acute pancreatitis caused by tegacyclin,if the clinical symptoms of the patient are nausea and vomiting,abdominal distension and abdominal pain,serum amylase,lipase levels and abdominal CT should be monitored to check whether acute pancreatitis is caused when using tigecycline.