左氧氟沙星致心律失常的发生特点和危险因素分析

Analysis of the characteristics and risk factors of levofloxacin-induced arrhythmias

目的 了解大样本住院人群中左氧氟沙星致心律失常的发生特点、临床表现和相关危险因素。方法 借助“临床药品不良事件主动监测与智能评估警示系统-Ⅱ”(ADE-ASAS-Ⅱ),回顾性监测2019年使用左氧氟沙星的住院患者电子病历信息,获得发生心律失常患者的相关数据,采用倾向性评分匹配法选取未发生心律失常患者,通过单因素和多因素条件logistic回归分析左氧氟沙星导致心律失常的危险因素。结果12 879例使用左氧氟沙星人群的相关心律失常发生率为1.64%,其中65岁及以上人群发生率为3.22%;主要表现为期外收缩(0.84%)、心动过速(0.63%)、QT间期延长(0.44%),无尖端扭转型室性心动过速和室颤等严重心律失常。多因素条件logistic回归分析结果显示,用药疗程较长[OR=1.030,95%CI(1.009,1.050),P=0.004]和静脉给药[OR=2.392,95%CI(1.478,3.870),P <0.001]是左氧氟沙星致心律失常的独立危险因素。结论 左氧氟沙星引起的心律失常较为常见,分布类型多样,其中QT间期延长为偶见;临床应用时,应更多关注静脉用药的老年患者,并尽量避免长疗程用药。

Objective To investigate the characteristics,clinical indicators and risk factors of levofloxacin-induced arrhythmias in large hospitalized populations.Methods Using the"Adverse Event Active Monitoring and Intelligent Assessment Alert System-II"(ADE-ASAS-II),the electronic medical record of inpatients using levofloxacin in 2019 was monitored to obtain relevant data for patients with arrhythmias.Patients without arrhythmia were selected by propensity score matching,and the risk factors of levofloxacin-induced arrhythmias were analyzed by univariate and multivariate conditional logistic regression.Results The incidence of levofloxacin-induced arrhythmias was 1.64%in 12879 people who used levofloxacin.The incidence in people over 65 years was 3.22%.The main manifestations of levofloxacin-induced arrhythmias were extrasystole(0.84%),tachycardia(0.63%),QT interval prolongation(0.44%),and no severe arrhythmias such as torsades de pointes and ventricular fibrillation.Multivariate Logistic regression analysis showed that the course of administration(OR=1.030,95%CI 1.009 to 1.050,P=0.004)and intravenous administration(OR=2.392,95%CI 1.478 to 3.870,P<0.001)independent risk factors for levofloxacin-induced arrhythmias.Conclusion Arrhythmias caused by levofloxacin are common and have various types,among which the occurrence of QT interval prolongation is occasional.We should pay more attention to elderly patients who receive intravenous levofloxacin and try to avoid long courses of medication.