中国临床药学杂志

目的 探究存在营养风险的住院患者中替加环素导致凝血功能异常的独立危险因素。方法 收集本院2023年7月1日至2024年6月30日使用替加环素且存在营养风险的病例，分为研究组（凝血功能异常）和对照组（凝血功能正常）。比较2组患者在性别、年龄、体质量、肝肾功能、血红蛋白、凝血功能、白蛋白水平、替加环素用法用量、疗程、合并疾病、合并用药、营养风险筛查2002(NRS-2002)等因素上的差异，对存在显著差异的指标进行单因素和多因素logistic回归分析，获得独立危险因素。结果 共纳入患者84例，其中研究组31例，对照组53例。2组在合并休克、合并肝/肾功能异常、替加环素用药疗程、年龄、NRS-2002、用药前凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、白蛋白水平方面差异均具有统计学意义（P<0.05）。经多因素logistic回归分析，发现用药疗程（OR=1.67,95%CI:1.20～2.31,P=0.002）和NRS-2002(OR=8.19,95%CI:2.11～31.75,P=0.002)可能是导致患者凝血功能异常的独立危险因素。ROC曲线分析显示，对于存在营养风险的患者，当疗程>6.5 d或NRS-2002评分> 3.5分时，其对替加环素致凝血功能异常具有显著的预测价值。结论 NRS-2002评分≥4分或用药疗程> 6.5 d的患者使用替加环素抗感染治疗时更应加强凝血功能监测，保障用药安全。

AIM To explore the independent risk factors for abnormal coagulation function caused by tigecycline in hospitalized patients with nutritional risks. METHODS Patients treated with tigecycline in our hospital between July 1, 2023 and June 30, 2024 and presenting nutritional risks were collected. They were divided into the study group(abnormal coagulation function) and the control group(normal coagulation function). Differences between the two groups of patients in terms of gender, age, weight, hepatic and renal function, hemoglobin quantity, coagulation function, albumin level, dosage and administration of tigecycline, treatment course, comorbidities, concomitant medications, nutritional risk screening 2002(NRS-2002) score, and other factors were compared. Univariate and multivariate logistic regression analysis was performed on the indicators with significant differences to obtain independent risk factors. RESULTS A total of 84 patients were included, with 31 patients in the study group and 53 Patients in the control group. There were significant differences between the 2 groups in terms of combined shock, combined hepatic and renal dysfunction, tigecycline treatment course, age, NRS-2002, prothrombin time(PT) before medication, activated partial thromboplastin time(APTT), and albumin level(P < 0.05). Multivariate logistic regression analysis was conducted, and it was found that the course of medication(OR=1.67, 95%CI:1.20-2.31, P = 0.002) and the NRS-2002(OR=8.19, 95%CI:2.11-31.75, P = 0.002) might be independent risk factors for abnormal coagulation function in patients. The cut-off values for independent risk factors were analyzed using the receiver operating characteristic(ROC) curve. The results showed that, among patients at nutritional risk, the course of treatment(> 6.5 days) and NRS-2002(> 3.5 points) had significant predictive value for tigecycline-induced abnormal coagulation function. CONCLUSION Patients with an NRS-2002 score of ≥ 4 or a medication course > 6.5 days need to strengthen the monitoring of coagulation function when using tigecycline for antiinfection treatment to ensure medication safety.