摘要
目的比较利奈唑胺与万古霉素在异基因造血干细胞移植（allo-HSCT）后感染治疗中的疗效差异，并评价利奈唑胺的安全性。方法回顾性收集北京大学血液病研究所2010年7月至2012年12月allo—HSCT后使用万古霉素或利奈唑胺抗革兰阳性菌感染的131例患者资料，对利奈唑胺组（42例）和万古霉素组（89例）患者的临床有效率及不良反应进行比较分析。结果使用万古霉素或利奈唑胺抗感染共计136例次，纳入疗效分析120例次。利奈唑胺组和万古霉素组的临床有效率分别为81．1％（30／37）和88．0％（73／83）（P=0．319）；两组总不良反应发生率相似[50．0％（23／46）比45．6％（41／90），P=0．623]；肾功能受累者均为轻度损伤[6．5％（3／46）比6．7％（6／90），P=1．000]；中重度肝损伤发生率分别为2．2％（1／46）和6．7％（6／90），P=0．244。对于造血未重建患者，两组的粒系和血小板植活时间相当；对于造血已重建患者，利奈唑胺并未引起白细胞、血小板明显减少。结论在治疗allo-HSCT后革兰阳性菌感染方面，利奈唑胺与万古霉素的疗效相当。因allo—HSCT后用药复杂，两药在此类人群中的不良反应发生情况有待进一步研究。
Objective To compare the efficacy and safety of linezolid and vancomycin in patients diagnosed as gram positive bacterial infections after receiving allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods A total of 131 patients who were confirmed or suspected as gram positive eoccal infections after allo-HSCT were enrolled in our study from July 2010 to December 2012. Patients were administrated with linezolid （600 mg every 12 h） or vancomycin （1 g every 12 h）. Clinical efficacy and safety were compared between the two groups. Results A total of 136 cases were detected gram positive coecal infections, among whom 120 cases were evaluable. Finally, 37 cases receiving linezolid and 83 cases receiving vancomycin were enrolled in this study. Clinical cure rates of infections were 81. 1% （30/37） and 88. 0% （73/83） in linezolid and vancomyein groups, respectively （P = 0. 319）. The incidence of adverse reactions was similar in the two groups [ 50. 0% （23/40） vs 45.6% （41/90） , P= 0. 623]. Drug-related renal function injury was mild [6.5% （3/46） vs 6.7% （6/90）, P = 1. 0001. The occurrence of liver damage with moderate and severe elevation enzymes was also similar between the two groups [2.2% （1/46） vs 6.7% （6/90）, P =0. 244]. As for hematologic events, linezolid was not found to have a negative effect on hematopoietie reconstitution. Conclusions Linezolid is as effective as vancomycin in the treatment of gram positive bacterial infeetions after allo-HSCT. Safety of Linezolid is also comparable with that of vancomycin, which needs to be further studied due to the complex interaction of medication in this special population.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2016年第2期97-101,共5页
Chinese Journal of Internal Medicine
基金
北京市科技计划项目科技北京百名领军人才培养工程（201228）
关键词
异基因造血干细胞移植
万古霉素
利奈唑胺
Allogeneic hematopoietic stem cell transplantation
Vancomycin
Linezolid
