替加环素致严重肾功能不全患者凝血功能异常的回顾性分析
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篇名: 替加环素致严重肾功能不全患者凝血功能异常的回顾性分析
TITLE: Retrospective analysis of coagulopathy in patients with severe renal insufficiency caused by tigecycline
摘要: 目的 分析替加环素对严重肾功能不全患者凝血功能的影响,为临床安全用药提供参考。方法回顾性分析2021年1月至2022年10月我院肾病学科收治的使用替加环素治疗的严重肾功能不全合并感染患者的临床资料。比较患者用药前3d,用药1~5、6~10、11~15、16~20d后及停药5d后和/或对症处理后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、国际标准化比值(INR)、血小板(PLT)、纤维蛋白原(FIB)水平。结果共纳入14例患者,有9例患者发生了凝血功能异常,发生率为64.29%。与用药前3d比较,患者用药6~10、11~15d后FIB水平及用药1~5、6~10、11~15d后PLT水平均显著降低,用药1~5、6~10d后PT及用药1~5、6~10、11~15d后APTT均显著延长,用药1~5、6~10d后INR均显著升高(P<0.05);而用药16~20d及停药5d后和/或对症处理后FIB、PT、INR、APTT、PLT与用药前3d比较,差异均无统计学意义(P>0.05)。结论严重肾功能不全患者需谨慎使用替加环素;替加环素可导致患者的PT、APTT延长,INR升高,PLT、FIB降低;用药疗程>14d时,临床需对患者凝血指标进行动态监测,以降低不良反应的发生风险。
ABSTRACT: OBJECTIVE To analyze the effects of tigecycline on coagulation function in patients with severe renal insufficiency, and to provide a reference for safe clinical drug use. METHODS Retrospective analysis was performed for the clinical data of patients with severe renal dysfunction complicated with infection receiving tigecycline admitted to nephrology department of our hospital from January 2021 to October 2022. The levels of prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), platelet (PLT) and fibrinogen (FIB) were compared 3 days before medication, with 1-5, 6-10, 11-15 and 16-20 days after medication, 5 days after withdrawal and/or after symptomatic treatment. RESULTS Finally, 14 patients were included, and 9 patients developed coagulopathy, with an incidence of 64.29%. Compared with 3 days after medication, the levels of FIB at 6-10 and 11-15 days after medication, and PLT at 1-5 , 6-10 and 11- 15 days after medication were decreased significantly, while the levels of PT at 1-5 and 6-10 days after medication, APTT at 1-5, 6-10 and 11-15 days after medication were significantly prolonged, and INR increased significantly at 1-5 and 6-10 days after medication (P<0.05). Compared with 3 days before medication, there were no statistically significant changes in FIB, PT, INR, APTT and PLT at 16-20 days after medication and 5 days after withdrawal and/or symptomatic treatment(P>0.05). CONCLUSIONS Patients with severe renal insufficiency should be cautious with tigecycline, which can lead to prolonged PT and APTT, increased INR, and decreased PLT and FIB. If medication time is over 14 days, dynamic monitoring of coagulation function indicators is recommended to reduce the risk of adverse reactions.
期刊: 2023年第34卷第22期
作者: 沈莉;方伟;张尧;潘洋;周泽伟
AUTHORS: SHEN Li,FANG Wei,ZHANG Yao,PAN Yang,ZHOU Zewei
关键字: 替加环素;凝血功能异常;肾功能不全;不良反应
KEYWORDS: tigecycline; coagulopathy; renal insufficiency; adverse reaction
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