CAJ | 학술논문

目的观察利奈唑胺治疗老年患者革兰阳性菌感染的有效性及其对血小板的影响.方法回顾性分析2008年1月至2010年10月我院内科系统收治的≥60岁老年革兰阳性菌感染患者50例,静脉应用利奈唑胺,观察患者症状及体征变化,进行病原体分析,评价其临床疗效并动态观察用药期间血小板变化. 结果 50例患者利奈唑胺治疗平均疗程(13±2)d,临床有效率74％,其中明确培养有革兰阳性球菌者26例,经治疗后细菌清除18例.利奈唑胺治疗过程中出现血小板减少24例(48％),治疗前后血小板计数均值分别为(239±114)×10 9/L和(146±87)×109/L,差异有统计学意义(t=3.888,P=0.000).血小板减少与患者用药前血小板计数及药物疗程有相关性,回归分析显示血小板计数＜200×109/L为风险预测指标(OR=0.244,95％ CI:0.068～0.874,P=0.030)；血小板随用药时间有一定的变化趋势,用药7d后明显下降,最低值位于停药1～2 d时.结论利奈唑胺治疗老年患者革兰阳性菌感染临床疗效和耐受性好,特别是应用于耐甲氧西林金黄色葡萄球菌等耐药革兰阳性菌院内获得性肺炎时；该药对老年患者肝肾功能影响较小,但可引起血小板减少,血小板减少与用药前患者血小板计数及利奈唑胺平均用药时间有关,可根据其变化规律加强监测,及时处理.
목적 관찰리내서알치료노년환자혁란양성균감염적유효성급기대혈소판적영향.방법 회고성분석2008년1월지2010년10월아원내과계통수치적≥60세노년혁란양성균감염환자50례,정맥응용리내서알,관찰환자증상급체정변화,진행병원체분석,평개기림상료효병동태관찰용약기간혈소판변화. 결과 50례환자리내서알치료평균료정(13±2)d,림상유효솔74％,기중명학배양유혁란양성구균자26례,경치료후세균청제18례.리내서알치료과정중출현혈소판감소24례(48％),치료전후혈소판계수균치분별위(239±114)×10 9/L화(146±87)×109/L,차이유통계학의의(t=3.888,P=0.000).혈소판감소여환자용약전혈소판계수급약물료정유상관성,회귀분석현시혈소판계수＜200×109/L위풍험예측지표(OR=0.244,95％ CI:0.068～0.874,P=0.030)；혈소판수용약시간유일정적변화추세,용약7d후명현하강,최저치위우정약1～2 d시.결론 리내서알치료노년환자혁란양성균감염림상료효화내수성호,특별시응용우내갑양서림금황색포도구균등내약혁란양성균원내획득성폐염시；해약대노년환자간신공능영향교소,단가인기혈소판감소,혈소판감소여용약전환자혈소판계수급리내서알평균용약시간유관,가근거기변화규률가강감측,급시처리.
Objective To study the efficacy of linezolid on gram positive bacterial infection in elderly patients and risk factors associated with thrombocytopenia.Methods A retrospective analysis of 50 elderly patients treated with intravenous linezolid for gram-positive bacterial infection from January 2008 to October 2010 was conducted.Clinical data and bacteriological responses were assessed.Efficacy of linezolid on infection and risk factors associated with thrombocytopenia in elderly patients were analyzed.Results The average duration of treatment was (13±2) d,the efficacy rate was 74 ％ and the bacteriological eradication rate was 69 ％ (18/26).Thrombocytopenia occurred in 24 patients during the treatment,and the average platelet count was significantly reduced compared with pretreatment[(146±87) 109/L vs.(239± 114) 109/L,t=3.888,P=0.000)].Thromhocytopenia was associated with the baseline platelet count and the mean time of linezolid treatment.Based on a Logistic regression analysis,the baseline platelet count ＜ 200 × 109/L was identified as the only significant risk factor for linezolid-associated thrombocytopenia in elderly patients (OR =0.244,95％CI:0.068-0.874,P=0.030).The mean platelet count was decreased significantly after 7 days of treatment,and decreased to the lowest value 1-2 days after the end of therapy.Conclusions Linezolid is effective and safe for the elderly with gram-positive bacterial infection,especially hospital acquired methicillin-resistant staphylococcus aureus infection.Linezolid has little effect on liver and renal function in elderly patients,but it can cause thrombocytopenia,which is associated with baseline platelet count and the mean time of linezolid treatment.Platelet counts should be monitored during treatment and measures should be taken to prevent hemorrhagic tendencies.