颅脑损伤对医院获得性肺炎患者利奈唑胺血药谷浓度的影响

Effect of Craniocerebral Injury on the Linezolid Trough Concentration in Patients withHospital Acquired Pneumonia

目的探讨颅脑损伤对使用利奈唑胺治疗医院获得性肺炎(HAP)患者血药谷浓度(C_(min))的影响。方法通过医院信息系统选取南京医科大学附属苏州医院神经外科、呼吸科、康复医学科确诊HAP并接受利奈唑胺治疗的患者65例,根据是否伴颅脑损伤分为颅脑损伤组(21例)和非颅脑损伤组(44例)。两组患者均予利奈唑胺(片剂或注射剂,用药剂量根据患者自身情况确定及调整)治疗。比较两组患者初始C_(min)、血小板减少症发生率等的差异,并采用线性回归分析预测C_(min)与肌酐清除率(CCr)之间的相关性。结果颅脑损伤组利奈唑胺中位初始C_(min)及其超标率均明显低于非颅脑损伤组(1.98 mg/L比9.45 mg/L,P<0.01;19.05%比68.18%,P<0.01),血小板减少症发生率明显低于非颅脑损伤组(0比22.73%,P=0.045)。利奈唑胺C_(min)与CCr颅脑损伤组无明显相关性(r=-0.358,P=0.111),非颅脑损伤组呈明显负相关(r=-0.313,P=0.046)。结论颅脑损伤患者利奈唑胺C_(min)不达标的风险较高,但发生血小板减少症的风险较低。临床应关注合并颅脑损伤HAP患者的利奈唑胺C_(min),并通过治疗药物监测调整给药剂量。

Objective To investigate the effect of craniocerebral injury on the linezolid trough concentration(C_(min))in patients with hospital acquired pneumonia(HAP).Methods A total of 65 patients diagnosed with HAP and treated with linezolid in the neurosurgery,respiratory and rehabilitation medicine departments of the Affiliated Suzhou Hospital of Nanjing Medical University were selected by the hospital information system,and they were divided into the craniocerebral injury group(21 cases)and the non-craniocerebral injury group(44 cases)based on the presence or absence of craniocerebral injury.The two groups were given Linezolid Tablets or Linezolid and Glucose Injection,with the dosage depending on the patients′actual condition.The initial C_(min)and incidence of thrombocytopenia between the two groups were compared,the correlation between C_(min)and creatinine clearance rate(CCr)was predicted by the linear regression analysis.Results The median initial C_(min)of linezolid and its over-standard rate in the craniocerebral injury group were significantly lower than those in the non-craniocerebral injury group(1.98 mg/L vs.9.45 mg/L,P<0.01;19.05%vs.68.18%,P<0.01);the incidence of thrombocytopenia was significantly lower than that in the non-craniocerebral injury group(0 vs.22.73%,P=0.045).There was no significant correlation between linezolid C_(min)and CCr in the craniocerebral injury group(r=-0.358,P=0.111),while they showed a significant negative correlation in the non-craniocerebral injury group(r=-0.313,P=0.046).Conclusion Patients with craniocerebral injury have a high risk of linezolid C_(min)below the target range,but a low risk of thrombocytopenia.We should pay attention to the linezolid C_(min)in patients with HAP and craniocerebral injury,and adjust the dosage through therapeutic drug monitoring in clinical practice.