Bo S Y, Su A M, Yang F, Yang L
Department of Geriatrics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2022 Jun 12;45(6):533-538. doi: 10.3760/cma.j.cn112147-20220212-00111.
To analyze the clinical data, especially the occurrence of hematotoxicity, of hospitalized elderly patients who took Linezolid (LZD), and to further explore the related risk factors. Our study enrolled the elderly inpatients treated with linezolid at the Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2018 to September 2021. The hospital information system data were retrieved to retrospectively analyze the clinical characteristics of patients, particularly the clinical characteristics and related risk factors of patients who experienced hematotoxic reactions to LZD. Of the 233 eligible cases included, 103 patients received empirical use of LZD (44.21%). The total effective rate was 76.39% (178/233). Among the 57 effective cases who received blood drug concentration monitoring, the trough concentration of LZD was high in 36.84 % (21/57) of elderly patients. Moreover, there were 15 patients with thrombocytopenia alone, 3 patients with decreased hemoglobin (HB) alone, and 3 patients with both thrombocytopenia and HB decrease. The patients who experienced hematotoxicity (developed a certain degree of hemoglobin decrease and/or thrombocytopenia) were more likely to be complicated with renal impairment (χ²=6.642, =0.036), concomitantly using proton pump inhibitor (PPI) (χ²=4.566, =0.033), and had a longer course of LZD treatment (=0.041). There was no linear correlation between the trough concentration of LZD and glomerular filtration rate evaluated by Modification of Diet in Renal Disease Formula (eGFR) (=0.226, =0.136). The elderly patients, especially those with renal impairment, concomitant treatment with PPI, and a longer course of LZD treatment, exhibited a higher risk of hematotoxicity during LZD treatment. Hence, we should strengthen the protection of renal function, reduce drug interaction, and dynamically monitor the blood drug concentration of LZD to adjust its dose, thus implementing safer and more effective treatments.
分析使用利奈唑胺（LZD）的住院老年患者的临床资料，尤其是血液毒性的发生情况，并进一步探讨相关危险因素。本研究纳入了2018年1月至2021年9月在南京大学医学院附属鼓楼医院接受利奈唑胺治疗的老年住院患者。检索医院信息系统数据，回顾性分析患者的临床特征，尤其是对LZD发生血液毒性反应患者的临床特征及相关危险因素。在纳入的233例符合条件的病例中，103例患者接受了LZD经验性使用（44.21%）。总有效率为76.39%（178/233）。在接受血药浓度监测的57例有效病例中，36.84%（21/57）的老年患者LZD谷浓度较高。此外，单纯血小板减少患者15例，单纯血红蛋白（HB）降低患者3例，血小板减少合并HB降低患者3例。发生血液毒性（出现一定程度的血红蛋白降低和/或血小板减少）的患者更易合并肾功能损害（χ²=6.642，P =0.036）、同时使用质子泵抑制剂（PPI）（χ²=4.566，P =0.033），且LZD治疗疗程较长（P =0.041）。LZD谷浓度与采用肾脏病饮食改良公式评估的肾小球滤过率（eGFR）之间无线性相关性（P =0.226，P =0.136）。老年患者，尤其是合并肾功能损害、同时接受PPI治疗且LZD治疗疗程较长的患者，在LZD治疗期间发生血液毒性的风险较高。因此，应加强肾功能保护，减少药物相互作用，并动态监测LZD血药浓度以调整剂量，从而实施更安全有效的治疗。
