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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (05) : 550 -554. doi: 10.3877/cma.j.issn.1674-6902.2019.05.003

论著

替加环素治疗重症肺炎不良反应分析
邵敏建1, 高蕾1, 钱倩2, 谈绮1, 黄茂1, 施毅3, 孙文逵1,†(), 戴山林1,†()   
  1. 1. 210029　南京，南京医科大学第一附属医院呼吸与危重症医学科
    2. 210029　南京，南京市胸科医院
    3. 210002　南京，东部战区总医院呼吸与危重症医学科
  • 收稿日期:2019-03-18 出版日期:2019-10-20
  • 通信作者: 孙文逵, 戴山林
  • 基金资助:
    国家自然科学基金资助项目(81770009，81500073，81800011); "六大人才高峰"资助项目(2015-WSN-086)

Adverse reactions of tigecycline in treatment of severe pneumonia

Minjian Shao1, Lei Gao1, Qian Qian2, Qi Tan1, Mao Huang1, Yi Shi3, Wenkui Sun1,†(), Shanlin Dai1,†()   

  1. 1. Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
    2. Nanjing Chest Hospital, Nanjing 210029, China
    3. Department of Respiratory and Critical Care Medicine, Eastern Theater General Hospital, Nanjing 210029, China
  • Received:2019-03-18 Published:2019-10-20
  • Corresponding author: Wenkui Sun, Shanlin Dai
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引用本文：

邵敏建, 高蕾, 钱倩, 谈绮, 黄茂, 施毅, 孙文逵, 戴山林. 替加环素治疗重症肺炎不良反应分析[J]. 中华肺部疾病杂志(电子版), 2019, 12(05): 550-554.

Minjian Shao, Lei Gao, Qian Qian, Qi Tan, Mao Huang, Yi Shi, Wenkui Sun, Shanlin Dai. Adverse reactions of tigecycline in treatment of severe pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(05): 550-554.

目的

探讨替加环素治疗重症肺炎患者的不良反应和超说明书剂量用药对不良反应的影响。

方法

选择南京医科大学第一附属医院呼吸重症监护病房(RICU)2016年7月至2018年6月使用替加环素治疗的患者，根据替加环素用量分为推荐剂量组和超剂量组，收集两组患者的一般资料、临床特征以及实验室检查，进行分析统计。

结果

纳入患者100例，整体观察发现31(31.00%)例出现不良反应，其中皮疹1例，消化系统不适9例，肝功能损伤10例，药物性血小板减少10例，肝功能损伤合并血小板减少1例。推荐剂量组和超剂量组比较，FIB血浆浓度差异有统计学意义(P<0.05)，其余不良反应分析差异无统计学意义。在替加环素联合1种或2种抗菌药物共用时，不良反应发生率别为30.77%(24/78例次)和40.00%(8/20例次)，组间比较差异无统计学意义(P>0.05)。替加环素用药前后比较发现，凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和凝血酶时间(TT)延长，纤维蛋白原(FIB)降低，尿素氮(BUN)升高，用药前后组间比较差异有统计学意义(P<0.05)。

结论

替加环素超剂量使用未明显增加不良反应。应用替加环素应关注肝肾功能损伤、血小板降低等不良反应，警惕药物对凝血系统的影响。

关键词: 替加环素, 不良反应, 重症肺炎, 超说明书用药
Objective

To investigate the adverse reactions of tigecycline in the treatment of severe pneumonia and the relationship between overdoses and adverse reaction rates.

Methods

The data of 100 patients with severe pneumonia receiving tigecycline in the Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Nanjing Medical University from July 2016 to June 2018 were analyzed retrospectively. The patients were divided into a recommended dose group (n=50) and an overdose group (n=50) according to the administration of tigecycline. The general information, clinical information and laboratory examination information were collected and statistically analyzed.

Results

Adverse reactions were observed in 31 cases (31.00%), including skin rash in 1 case, alimentary system reaction in 9, liver function damage in 10, thrombopenia in 10 and liver function damage complicated with thrombopenia in 1. Significant difference of fibrinogen (FIB) was found between the recommended dose group and the overdose group (P<0.05), however, no statistical significant difference was found between the two groups in the other adverse reactions. The incidences of adverse reactions were 30.77% (24/78 case-times) and 40.00% (8/20 case times), respectively, of all the tigecycline takers who were given one or two antibacterials at the same time, but there was no statistical significant difference between the two groups (P>0.05). Before and after use of tigecycline, significant differences were found in the prothrombin time (PT), the activated partial thromboplastin time (APTT), the thrombin time (TT), FIB and the blood urea nitrogen (BUN).

Conclusion

The incidence of adverse reactions was not significantly increased when taking overdose tigecycline. Special attention should be paid to the blood coagulation system, the liver and the renal function and the level of platelets when using tigecycline.

Key words: Tigecycline, Adverse drug reaction, Severe pneumonia, Off-label drug use
表1 替加环素与抗菌药物联用的不良反应[n(%)]
联合用药 例数 消化系统 肝功能损伤 血小板减少 皮疹
TGC+1种抗菌药物 78 7(8.97) 9(11.54) 8(10.26)  
TGC+2种抗菌药物 20 2(10.00) 2(10.00) 3(15.00) 1(5.00)
表2 两组患者不良反应[n(%)]
组　别 例数 胃肠道反应 血小板减少 肝功能损伤
推荐剂量组 21 0 3(14.29) 2(9.52)
超剂量组 79 9(11.39) 8(10.13) 9(11.39)
χ2值   1.42 0.22 0.00
P值   0.23 0.88 1.00
1
Manea E, Sojo-Dorado J, Jipa RE, et al. The role of tigecycline in the management of Clostridium difficile infection: a retrospective cohort study[J]. Clin Microbiol Infect, 2018, 24(2): 180-184.
2
Shankar C, Nabarro L, Anandan S, et al. Minocycline and Tigecycline：What Is Their Role in the Treatment of Carbapenem-Resistant Gram-Negative Organisms？[J]. Microb Drug Resist, 2017, 23(4): 437-446.
3
中国医药教育协会感染疾病专业委员会. 抗菌药物超说明书用法专家共识[J]. 中华结核和呼吸杂志，2015, 38(6): 410-444.
4
Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5): e61-e111.
5
陈佰义，何礼贤，胡必杰，等. 中国鲍曼不动杆菌感染诊治与防控专家共识[J]. 中国医药科学，2012, 2(08): 3-8.
6
De Pascale G, Montini L, Pennisi M, et al. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria[J]. Crit Care, 2014, 18(3): R90.
7
中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J]. 中华结核和呼吸杂志，2016(4): 253-279.
8
Ye S, Zhang C, Lin S. Preliminary experience with tigecycline treatment for severe infection in children[J]. Eur J Pediatr, 2018，177(10): 1489-1496.
9
Bender JK, Cattoir V, Hegstad K, et al. Update on prevalence and mechanisms of resistance to linezolid, tigecycline and daptomycin in enterococci in Europe: Towards a common nomenclature[J]. Drug Resist Updat, 2018, 40: 25-39.
10
史金英，宋　宁，柴书坤，等. 替加环素联合头孢哌酮/舒巴坦治疗泛耐药鲍氏不动杆菌的临床研究[J]. 中华医院感染学杂志，2015(8): 1750-1752.
11
杭　欣，张　波. 替加环素治疗耐药肺炎克雷伯菌肺部感染的疗效评价[J]. 北方药学，2016(5): 33.
12
李昱霖，梁志欣，王　彬，等. 替加环素不良反应回顾性分析[J]. 中国药物应用与监测，2014(02): 111-114.
13
朱　曼，田小燕，郭代红，等. 替加环素药源性肝损伤与胰腺炎的主动监测研究[J]. 中华医院感染学杂志，2017(20): 4581-4583, 4603.
14
Hemphill MT, Jones KR. Tigecycline-induced acute pancreatitis in a cystic fibrosis patient: A case report and literature review[J]. J Cyst Fibros, 2016, 15(1): e9-e11.
15
Bernas AA, Aveiga VD, Etxeberria ZL, et al. Acute pancreatitis in ICU secondary to treatment with tigecycline[J]. Rev Esp Anestesiol Reanim, 2017, 64(1): 46-49.
16
Leng B, Xue YC, Zhang W, et al. A Retrospective Analysis of the Effect of Tigecycline on Coagulation Function[J]. Chem Pharm Bull (Tokyo), 2019, 67(3): 258-264.
17
McMahan J, Moenster RP. Tigecycline-induced coagulopathy[J]. Am J Health Syst Pharm, 2017, 74(3): 130-134.
18
Brink AJ, Bizos D, Boffard KD, et al. Guideline summary: appropriate use of tigecycline[J]. S Afr J Surg, 2012, 50(1): 20-21.
19
Broeker A, Wicha SG, Dorn C, et al. Tigecycline in critically ill patients on continuous renal replacement therapy: a population pharmacokinetic study[J]. Crit Care, 2018, 22(1): 341.
20
李雪芹，王桂凤，刘　峰. 替加环素治疗泛耐药鲍曼不动杆菌感染临床疗效及安全性分析[J]. 中国药物应用与监测，2015(02): 108-111.
21
Kadoyama K, Sakaeda T, Tamon A, et al. Adverse event profile of tigecycline: data mining of the public version of the U．S. Food and Drug Administration adverse event reporting system[J]. Biol Pharm Bull, 2012, 35(6): 967-970.
22
吴　冰，陈世耀. 替加环素致肌酐水平升高1例[J]. 中国药物应用与监测，2014(04): 253-254.
23
Korth-Bradley JM, Troy SM, Matschke K, et al. Tigecycline pharmacokinetics in subjects with various degrees of renal function[J]. J Clin Pharmacol, 2012, 52(9): 1379-1387.
24
Miller CS, McGarity GJ. Tetracycline-induced renal failure after dental treatment[J]. J Am Dent Assoc, 2009, 140(1): 56-60.
25
Maximova N, Zanon D, Verzegnassi F, et al. Neutrophils engraftment delay during tigecycline treatment in 2 bone marrow-transplanted patients[J]. J Pediatr Hematol Oncol, 2013, 35(1): e33-e37.
26
Tang C, Yang L, Jiang X, et al. Antibiotic drug tigecycline inhibited cell proliferation and induced autophagy in gastric cancer cells[J]. Biochem Biophys Res Commun, 2014, 446(1): 105-112.
27
Zhang Q, Zhou S, Zhou J. Tigecycline treatment causes a decrease in fibrinogen levels[J]. Antimicrob Agents Chemother, 2015, 59(3): 1650-1655.
28
Warn P, Thommes P, Sattar A, et al. Disease Progression and Resolution in Rodent Models of Clostridium difficile Infection and Impact of Antitoxin Antibodies and Vancomycin[J]. Antimicrob Agents Chemother, 2016, 60(11): 6471-6482.
29
Giryes S, Azzam ZS, Ismael-Badarneh R, et al. Severe Coagulation Disorder and Thrombocytopenia Associated with Tigecycline-Case Report and Review of Literature[J]. Curr Drug Saf, 2017, 12(1): 7-9.
30
Zhang Z, Chen X, Hernandez LD, et al. Toxin-mediated paracellular transport of antitoxin antibodies facilitates protection against Clostridium difficile infection[J]. Infect Immun, 2015, 83(1): 405-416.
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