哌拉西林他唑巴坦钠诱导血液病患者免疫性溶血反应观察

Observation of piperacillin-tazobactam sodium-induced immune hemolytic reaction in patients with hematological diseases

目的:分析哌拉西林他唑巴坦钠诱导血液病患者药物抗体的发生率及其引起免疫性溶血反应的情况。方法:选择153例静脉使用哌拉西林他唑巴坦钠治疗的血液病患者,采用微柱凝胶技术对首次用药后第3、5、7和10天的血液样本进行直接抗球蛋白试验(DAT)和哌拉西林他唑巴坦钠药物抗体检测。结果:153例血液病患者首次用药后第3、5、7和10天的DAT阳性率分别为7.2%、15.0%、21.6%和24.2%(P<0.001);DAT阳性组中药物抗体阳性率分别为9.1%、21.7%、24.2%和24.3%(P=0.801)。DAT阳性组与DAT阴性组、DAT阳性患者中药物抗体阳性组与阴性组性别、年龄比较,差异均无统计学意义(P>0.05)。结论:血液病患者在使用哌拉西林他唑巴坦钠治疗过程中,需要动态监测药物抗体,以避免药物诱导的免疫性溶血性贫血的发生。

Aim:To explore the incidence of piperacillin-tazobactam sodium antibodies and the induced immune hemolytic reaction in patients with hematological diseases.Methods:The blood samples from 153 hematologic patients were collected on the 3rd,5th,7th and 10th day after being treated with piperacillin-tazobactam sodium.The direct antiglobulin test(DAT)of the red cells and drug antibodies were examined using the micro gel column technique.Results:In the 153 patients with hematological diseases,the positive rates of DAT and drug antibodies were 7.2%,15.0%,21.6%,24.2%(P<0.001)and 9.1%,21.7%,24.2%,24.3%(P=0.801),respectively on the 3rd,5th,7th,10th day after piperacillin-tazobactam sodium treatment.Between the DAT positive and negative groups,as well as between the drug antibody positive and negative groups with DAT positive,there were no significant differences in gender or age(P>0.05).Conclusion:Dynamic monitoring of drug related antibodies should be carried out to avoid drug-induced immune hemolytic anemia in patients with hematological diseases during the treatment with piperacillin-tazobactam sodium.