应用替加环素治疗重症感染患者DILI发生及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2024.02.014

摘要/Abstract

摘要： 目的分析应用替加环素治疗重症感染患者发生药物性肝损伤(DILI)的临床特点, 并探讨影响DILI发生的因素。方法 2022年1～12月我院重症监护病房收治的重症感染患者74例, 分别给予替加环素50 mg(n=27)或100 mg(n=47), 加入0.9%氯化钠溶液250毫升中静脉滴注, 2次/d, 治疗5～14 d。应用多因素Logistic回归分析影响DILI发生的危险因素, 应用受试者工作特征曲线(ROC)分析诊断效能。结果在治疗后, 本组患者发生DILI者36例(48.6%);DILI组合并糖尿病、高血压、恶性肿瘤占比分别为50.0%、47.2%、33.3%, 均显著高于未发生DILI组(18.4%、23.7%、13.2%, P<0.05);DILI组替加环素血药浓度的曲线下面积(AUC_0-24h)为(17.6±6.6) mg·h·L^-1, 显著高于非DILI组【(14.0±7.3)mg·h·L^-1, P<0.05】;多因素Logistic回归分析显示, 合并糖尿病【OR: 4.253(95%CI:1.224～14.773)】, 合并恶性肿瘤【OR: 4.818(95%CI:1.300～17.856)】和AUC_0-24_h【OR: 1.106(95%CI:1.022～1.197)】是重症感染患者应用替加环素出现DILI的独立危险因素(P<0.05);ROC分析发现, 以替加环素AUC_0-24_h=14.78 mg·h·L^-1为截断点, 其预测DILI发生的敏感性和特异性分别为66.7%和65.8%。结论熟悉重症感染患者应用替加环素出现DILI的常见危险因素有助于早期做好防治工作, 监测血药浓度, 采取个体化的药物治疗方案, 或可降低DILI发生率。

关键词: 药物性肝损伤, 重症感染, 替加环素, 影响因素

Abstract: Objective The aim of this study was to analyze the clinical features and influencing factors of drug-induced liver injury (DILI) in patients with severe infection receiving tigecycline therapy. Methods 74 patients with severe infection were encountered in the intensive care unit of our hospital between January and December 2022, and all were treated with tigecycline at 50 mg(n=27) or 100 mg(n=47), intravenously, q12h, for 7-14 days. The multivariate Logistic regression analysis were applied to reveal the risk factors of DILI occurrence, and the receiver operating characteristic curve (ROC) was applied to predict the efficacy. Results During the antibacterial treatment period, the DILI was found in 36 cases (48.6%); the incidence of concomitant diabetes, hypertension and malignant tumors in patients with DILI were 50.0%, 47.2% and 33.3%, all significantly higher than 18.4%, 23.7% and 13.2% (P<0.05) in patients without DILI; the AUC_0-24h of blood tigecycline concentration in patients with DILI was (17.6±6.6) mg·h·L^-1, much higher than in patients without DILI; the multivariate Logistic regression analysis showed that the concomitant diabetes, malignant tumors and AUC_0-24_h were all the independent risk factors for the occurrence of DILI (P<0. 05); the ROC analysis showed that when serum tigecycline’s AUC_0-24_h=14.78 mg·h·L^-1 was set as the cut-off-value in predicting DILI occurrence, the sensitivity and specificity were 66.7% and 65.8%, respectively. Conclusion The clinicians should take the precipitating factors of DILI into consideration in critically infected patients when the tigecycline is used, and we recommend monitoring blood drug concentration for making a personalized therapeutic plan to reduce DILI occurrence.

Key words: Drug-induced liver injury, Severe infection, Tigecycline, Risk factors

张天祺, 王敏, 杨娜, 朱怀军. 应用替加环素治疗重症感染患者DILI发生及其影响因素分析^*[J]. 实用肝脏病杂志, 2024, 27(2): 214-217.

Zhang Tianqi, Wang Min, Yang Na, et al.. Drug-induced liver injury in ICU patients with severe infection receiving tigecycline therapy: An analysis of 74 cases[J]. Journal of Practical Hepatology, 2024, 27(2): 214-217.

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应用替加环素治疗重症感染患者DILI发生及其影响因素分析^*

Drug-induced liver injury in ICU patients with severe infection receiving tigecycline therapy: An analysis of 74 cases

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