回顾性探究质子泵抑制剂对替加环素抗感染治疗效果的影响

Retrospective exploration of the impact of proton pump inhibitors on the clinical efficacy of tigecycline

目的探究质子泵抑制剂(PPIs)的使用是否影响替加环素抗感染的临床疗效,为替加环素与PPIs是否联合应用提供证据,以探寻更优的临床用药方案。方法回顾性分析2020年1月至2023年12月于内蒙古自治区人民医院使用替加环素抗感染患者的临床资料。根据纳入标准,共筛选出306例患者,按照治疗方法分组,替加环素联用PPIs组(T+P组)161例,替加环素未联用PPIs组(T组)145例。主要结局包括全因死亡率和临床有效率。次要结局包括住院时间、体温、微生物清除率。采用Logistic回归分析检验影响临床疗效的独立因素。结果T+P组临床有效率37.3%低于T组临床有效率49.7%,差异有统计学意义(χ^(2)=4.77,P=0.03),T+P组患者治疗后体温(37.1±0.8)℃高于T组(36.9±0.7)℃,差异有统计学意义(t=-2.1,P=0.04)。2组患者在全因死亡率、微生物清除率、住院时间均差异无统计学意义。多因素Logistic回归分析发现,替加环素联用PPIs是影响临床有效的独立危险因素[OR(95%CI):0.45(0.27,0.76),P<0.01],提示替加环素联用PPIs时临床有效率是未联用PPIs的0.45倍。T+P组发生消化道不良反应的概率23.6%高于T组13.8%,差异有统计学意义(P=0.03),2组患者发生凝血功能障碍差异无统计学意义。结论在替加环素抗感染治疗时,联用PPIs会降低临床疗效在临床上使用替加环素抗感染治疗时应谨慎联合使用PPIs。

Objective To investigate whether the use of proton pump inhibitors(PPIs)affects the clinical efficacy of tigecycline,and to provide clinical evidence for the combination of tigecycline and PPIs,thereby exploring better clinical drug selection options.Methods A retrospective analysis was conducted on the clinical data of patients treated with tigecycline for antiinfection in Inner Mongolia People′s Hospital from January 2020 to December 2023.Based on inclusion and exclusion criteria,a total of 306 patients were selected:161 patients in the tigecycline combined with proton pump inhibitors group(T+P group)and 145 patients in the tigecycline without proton pump inhibitors group(T group).The main outcomes included all-cause mortality and clinical efficacy.Sec-ondary outcomes included length of hospital stay,body temperature,and microbial clearance rate.Logistic regres-sion analysis was used to examine independent factors affecting clinical efficacy.Results The clinical effective rate in T+P group was lower than that in the T group(37.3%vs 49.7%),and the difference was statistically signifi-cant(χ^(2)=4.77,P=0.03).The average body temperature after treatment in the T+P group was higher than that in the T group[(37.1±0.8℃)vs(36.9±0.7℃)],and the difference was statistically significant(P=0.04).There was no statistical difference in all-cause mortality,microbiological clearance rate and hospital stay between the two groups.Multivariate Logistic regression analysis revealed that the combination of tigecycline and PPIs was an in-dependent risk factor affecting clinical efficacy[OR(95%CI):0.45(0.27,0.76),P<0.01],suggesting that the proba-bility of clinical efficacy when tigecycline was combined with PPIs was 0.45 times that of tigecycline alone.The probability of gastrointestinal adverse reactions in the T+P group was higher than that in the T group(23.6%vs 13.8%),and the difference was statistically significant(P=0.03),while there was no difference in coagulation dysfunction between the two groups of patients.Conclusion The co-administration of PPIs during tigecycline anti-infection therapy may reduce clinical efficacy,but the specific mechanism remains unclear.Therefore,caution should be exercised when using PPIs in combination with tigecycline for anti infective treatment in clinical practice.