中国药物警戒 ›› 2022, Vol. 19 ›› Issue (3): 306-309.
DOI: 10.19803/j.1672-8629.2022.03.16

• 安全与合理用药 • 上一篇    下一篇

氟喹诺酮类药物致血小板减少症的临床特点及危险因素分析

陈聪聪1, 谭瑞娟1, 王立丹1, 张媛媛1, 胡晓妍2, 陈园园1   

  1. 1衡水市人民医院药学部,河北 衡水,053000;
    2衡水市第四人民医院药剂科,河北 衡水,053000
  • 收稿日期:2020-05-06 出版日期:2022-03-15 发布日期:2022-03-16
  • 通讯作者: *王立丹,女,本科,副主任药师,临床药学。E-mail：381734789@qq.com
  • 作者简介:陈聪聪,女,本科,主管护师,医院药学。
  • 基金资助:
    衡水市科技计划与发展项目(2016014097Z)

Clinical characteristics and risk factors of thrombocytopenia induced by fluoroquinolones

CHEN Congcong1, TAN Ruijuan1, WANG Lidan1, ZHANG Yuanyuan1, HU Xiaoyan2, CHEN Yuanyuan1   

  1. 1Department of Pharmacy, Hengshui People's Hospital, Hengshui Hebei 053000, China;
    2Department of Pharmacy, Hengshui Fourth People's Hospital, Hengshui Hebei 053000, China;
  • Received:2020-05-06 Online:2022-03-15 Published:2022-03-16

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摘要： 目的 探讨氟喹诺酮类药物致血小板减少症的临床特点,并进行相关危险因素分析,为临床的合理安全用药提供依据。方法 采用回顾性研究方法,选取衡水市人民医院和衡水市第四人民医院药品不良反应（ADR）监测系统2015年1月1日至 2019年12月31日上报的氟喹诺酮类药物致ADR病例596例,根据是否发生血小板减少症分为血小板减少症组（44例）和非血小板减少症组（552例）,应用单因素和多因素逐步Logistic回归分析其相关危险因素。结果 氟喹诺酮类药物致血小板减少症占总ADR的7.38%,血小板计数低于正常值75%的有26例（59.09%）、低于正常值50%~75%的有12例（27.27%）、低于正常值50%的有6例（13.64%）,停药后逐渐恢复正常。单因素及多因素分析显示,APACHE-II评分≥20分（OR=2.09,95% CI=1.10~3.99,P=0.022）、肌酐清除率≤30 mL·min-1（OR=2.01,95%CI=1.08~3.75,P=0.031）、大剂量用药（OR=2.02,95%CI=1.08~3.72,P=0.028）和用药时间≥14 d（OR=1.95,95%CI=1.04~3.64,P=0.043）是氟喹诺酮类药物致血小板减少症的独立危险因素。结论 对于使用氟喹诺酮类药物的患者,需要警惕血小板减少症的发生,尤其是重症（APACHE-II评分≥20）、肾功能不全（肌酐清除率≤30 mL·min-1）、大剂量用药和长时间用药（≥14 d）的患者。

关键词: 氟喹诺酮类药物, 左氧氟沙星, 莫西沙星, 环丙沙星, 培氟沙星, 加替沙星, 血小板减少症, 危险因素

Abstract: Objective To investigate the prevalence of and risk factors for thrombocytopenia caused by fluoroquinolones in order to provide reference for rational use of fluoroquinolones. Methods A retrospective study was made of 596 cases of adverse drug reactions (ADR) in two hospitals between Jan 1, 2015 and Dec 31, 2019. According to the diagnostic criteria for thrombocytopenia, these patients were divided into the thrombocytopenia group (44 patients) and non- thrombocytopenia group (552 patients). Univariate and multiple logistic regression analysis was used to identify risk factors related to thrombocytopenia. Results Thrombocytopenia caused by fluoroquinolones accounted for 7.38% of the total ADR. There were 26 cases (59.09%) with platelet counts below 75% of the normal level, 12 cases (27.27%) below 50%~75% of the normal level, and 6 cases (13.64%) below 50% of the normal level. After discontinuation of medication, those symptoms gradually returned to normal. Univariate and multivariate logistic analysis showed that APACHE-II score ≥20 points (OR = 2.09, 95%CI=1.10 to 3.99, P=0.022), creatinine clearance rate≤30 mL·min-1 (OR=2.01, 95%CI= 1.08 to 3.75, P=0.031), overdose medication (OR= 2.02, 95%CI=1.08 to3.72, P=0.028) and duration of medication ≥14 days (OR=1.95, 95%CI=1.04 to 3.64, P=0.043 ) were independent risk factors for thrombocytopenia caused by fluoroquinolones. Conclusion When patients are using fluoroquinolones, clinicians should be alert to the occurrence of thrombocytopenia, especially among severe cases (APACHE-II score≥20) or cases with renal insufficiency (creatinine clearance ≤30 mL·min-1), overdose medication and long-term medication (≥14 days).

Key words: fluoroquinolones, levofloxacin, moxifloxacin, ciprofloxacin, pefloxacin, gatifloxacin, thrombocytopenia, risk factors

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