莫西沙星与左氧氟沙星在心脏重症监护病房患者中QT间期延长发生率的比较及相关危险因素分析

Comparison of QT interval prolongation incidence in cardiology intensive care unit patients treated with moxifloxacin versus levofloxacin and analysis of related risk factors

目的研究莫西沙星与左氧氟沙星抗感染治疗在心脏重症监护病房(CCU)患者中QT间期延长发生率的差异,并分析发生QT间期延长的危险因素。方法收集2020年1月至2022年12月孝感市中心医院CCU中接受莫西沙星和左氧氟沙星抗感染治疗患者的临床资料进行回顾性分析,比较两组患者的临床特征。单因素回归分析筛选可能与QT间期延长相关的影响因素,将其中P<0.2的变量纳入logistic回归模型进行多因素分析。效应值采用比值比(OR)及其95%置信区间(CI)表示。结果共146例患者纳入研究,其中莫西沙星组76例,左氧氟沙星组70例。莫西沙星组76例患者发生QT间期延长18例,发生率23.68%;左氧氟沙星组70例患者发生QT间期延长6例,发生率8.57%;2组间差异具有统计学意义(P=0.025);2组间其他因素差异无统计学意义。单因素回归分析结果显示,女性(OR=2.958,95%CI:1.144~7.647,P=0.025),心肌梗死(OR=2.958,95%CI:1.144~7.647,P=0.025),合并使用胺碘酮(OR=2.569,95%CI:1.042~6.337,P=0.040)、艾司西酞普兰(OR=0.397,95%CI:0.158~0.997,P=0.049)是发生QT间期延长的影响因素。将P<0.2的相关因素纳入多因素logistic回归分析,结果显示,女性(OR=3.616,95%CI:1.240~10.538,P=0.019)、低血钾(OR=2.953,95%CI:1.263~6.905,P=0.012)、心肌梗死(OR=3.026,95%CI:1.057~8.666,P=0.039)是发生QT间期延长的独立危险因素。结论莫西沙星导致QT间期延长发生率较左氧氟沙星高,女性、低血钾、伴有心肌梗死的患者发生QT间期延长的风险较高。

Objective To investigate the differences in the incidence of QT interval prolongation between moxifloxacin and levofloxacin in anti⁃infective therapy among cardiology intensive care unit(CCU)patients,and to analyze the risk factors for QT interval prolongation.Methods The data of patients who received anti⁃infective treatments with moxifloxacin and levofloxacin in CCU of Xiaogan Central Hospital from January 2020 to December 2022 were collected and analyzed retrospectively.The clinical characteris⁃tics in the 2 groups were compared.Potential influencing factors of QT interval prolongation were analyzed using univariate regression analysis.Variables with P<0.2 were included in a logistic regression model for multivariate analysis.The effect values were expressed as odds ratio(OR)and its 95%confidence interval(CI).Results A total of 146 patients were included in the study,with 76 patients in the moxifloxacin group and 70 patients in the levofloxacin group.In the moxifloxacin group,18 out of 76 patients(23.68%)experienced QT interval prolongation,while in the levofloxacin group,6 out of 70 patients(8.57%)experi⁃enced QT interval prolongation;the difference between the 2 groups was statistically significant(P=0.025).There were no statistically significant differences in other factors between the 2 groups.Univariate regression analysis showed that female(OR=2.958,95%CI:1.144-7.647,P=0.025),myocardial infarction(OR=2.958,95%CI:1.144-7.647,P=0.025),concomitant use of amiodarone(OR=2.569,95%CI:1.042-6.337,P=0.040)and escitalopram were influencing factors of QT interval prolongation.Factors with P<0.2 were entered in the multivariate logistic regression analysis,and the results showed that female(OR=3.616,95%CI:1.240-10.538,P=0.019),hypokalemia(OR=2.953,95%CI:1.263-6.905,P=0.012),and myocardial infarc⁃tion(OR=3.026,95%CI:1.057-8.666,P=0.039)were independent risk factors for QT interval prolongation.Conclusions Moxifloxacin is associated with a higher incidence of QT interval prolongation compared to levofloxacin.Female and patients with hypokalemia and myocardial infarction have high risks for QT interval prolongation.