利奈唑胺相关低钠血症危险因素分析及其列线图模型建立

秦艳; 叶岩荣; 沈赟; 陈喆; 盛慧洁; 李晓宇; 吕迁洲

doi:10.6039/j.issn.1001-0408.2022.23.14

您当前的位置：

首页 >

文章列表页 >

利奈唑胺相关低钠血症危险因素分析及其列线图模型建立

药物与临床 | 更新时间：2023-02-22

- 利奈唑胺相关低钠血症危险因素分析及其列线图模型建立
- Risk factor analysis of linezolid-induced hyponatremia and the establishment of its nomogram model
- 中国药房 2022年33卷第23期页码：2891-2894
- 作者机构：
  
  复旦大学附属中山医院药剂科，上海　200032
- 作者简介：
  
  主管药师，硕士。研究方向：医院药学。电话：021-64041990。E-mail：celeryan@163.com
  副主任药师。研究方向：医院药学、药事管理。电话：021-64041990。E-mail：ye.yanrong@zs-hospital.sh.cn
- 基金信息：
  
  复旦大学附属中山医院项目(2020ZSQN53)
- DOI：10.6039/j.issn.1001-0408.2022.23.14
  中图分类号： R978.1;R969.3
- 纸质出版日期：2022-12-15，
  
  收稿日期：2022-06-17，
  
  修回日期：2022-10-10，
扫描看全文
秦艳,叶岩荣,沈赟等.利奈唑胺相关低钠血症危险因素分析及其列线图模型建立 ^Δ[J].中国药房,2022,33(23):2891-2894.

QIN Yan,YE Yanrong,SHEN Yun,et al.Risk factor analysis of linezolid-induced hyponatremia and the establishment of its nomogram model[J].ZHONGGUO YAOFANG,2022,33(23):2891-2894.
秦艳,叶岩荣,沈赟等.利奈唑胺相关低钠血症危险因素分析及其列线图模型建立 ^Δ[J].中国药房,2022,33(23):2891-2894. DOI： 10.6039/j.issn.1001-0408.2022.23.14.

QIN Yan,YE Yanrong,SHEN Yun,et al.Risk factor analysis of linezolid-induced hyponatremia and the establishment of its nomogram model[J].ZHONGGUO YAOFANG,2022,33(23):2891-2894. DOI： 10.6039/j.issn.1001-0408.2022.23.14.

摘要

目的

分析利奈唑胺相关低钠血症的危险因素，建立利奈唑胺致低钠血症的列线图模型。

方法

回顾性收集复旦大学附属中山医院2019年4月至2021年5月接受利奈唑胺治疗的142例患者资料，包括患者的人口统计学特征、实验室检查指标、合并疾病和联合用药等情况。根据是否发生低钠血症分为低钠血症组和非低钠血症组，采用单因素分析比较两组间变量的差异，通过多因素Logistic回归分析研究利奈唑胺相关低钠血症的独立危险因素；在此基础上建立列线图模型用于识别利奈唑胺致低钠血症的发生风险，采用受试者工作特征（ROC）曲线和校准曲线、Hosmer-Lemeshow拟合优度检验评估模型的预测效能。

结果

142例患者中，有30例患者发生低钠血症，112例患者未发生低钠血症，不良反应发生率为21.1%。单因素分析结果显示，低钠血症组与非低钠血症组患者的利奈唑胺谷浓度、基线血清钠、白细胞计数、总胆红素、白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、联合使用螺内酯比较，差异有统计学意义（

＜0.05）。多因素Logistic回归分析结果显示，利奈唑胺谷浓度[OR＝1.128，95%CI（1.028，1.239）]、基线血清钠[OR＝0.719，95%CI（0.604，0.857）]

和总胆红素[OR＝1.007，95%CI（1.002，1.011）]是利奈唑胺相关低钠血症的独立危险因素（

＜0.05）。列线图模型ROC曲线下面积（95%CI）为0.874（0.794，0.995），灵敏度和特异度分别为88.4%和76.7%；校准曲线的平均绝对误差为0.017；Hosmer-Lemeshow拟合优度检验结果显示，风险预测值与实测值比较，差异无统计学意义（

＝4.941，

＝0.064）。

结论

利奈唑胺谷浓度、基线血清钠和总胆红素是利奈唑胺相关低钠血症的独立危险因素；在此基础上建立的列线图模型对于利奈唑胺相关低钠血症的发生具有较好的预测价值。

Abstract

OBJECTIVE

To analyze the risk factors of linezolid-induced hyponatremia， and establish nomogram model of linezolid-induced hyponatremia.

METHODS

The clinical information of 142 patients who received linezolid therapy were collected from Zhongshan Hospital Affiliated to Fudan University from April 2019 to May 2021 including demographic characteristics， laboratory index， concomitant disease and drug combination. They were divided into hyponatremia group and non-hyponatremia group according to whether hyponatremia occurred； univariate analysis was used to compare the differences of variables between the two groups； the independent risk factors for linezolid-induced hyponatremia were analyzed by multivariate Logistic regression. The nomogram model was set up to identify the occurrence risk of linezolid-induced hyponatremia， receiver operating characteristic （ROC） curve and calibration curve， Hosmer-Lemeshow goodness-of-fit test were used to evaluate the predictive effectiveness of the model.

RESULTS

Of 142 patients， 30 patients suffered from hyponatremia， and 112 patients did not suffer， the incidence of adverse drug reaction was 21.1%. Univariate analysis showed that there was statistical significance in trough concentration of linezolid， baseline serum sodium， white blood cell count， total bilirubin， albumin， alanine aminotransferase， aspartate aminotransferase， combined use of spironolactone between hyponatremia group and non-hyponatremia group （

＜0.05）. Multivariate Logistic regression analysis showed that trough concentration of linezolid [OR＝1.128， 95%CI（1.028-1.239）]， baseline serum sodium [OR＝0.719， 95%CI（0.604-0.857）]

and total bilirubin [OR＝1.007， 95%CI（1.002， 1.011）] were independent risk factors for linezolid-induced hyponatremia （

＜0.05）. The area under the ROC curve （95%CI） of the nomogram model was 0.874 （0.794-0.995）； the sensitivity and specificity were 88.4% and 76.7%. The average absolute error of calibration curve was 0.017. The results of Hosmer-Lemeshow goodness-of-fit test showed that there was no statistically significant difference between the predicted risk value and the measured value （

＝4.941，

＝0.064）.

CONCLUSIONS

The trough concentration of linezolid， baseline serum sodium and total bilirubin are independent risk factors for linezolid-induced hyponatremia. The established nomogram model shows well predictive performance to identify linezolid-induced hyponatremia.

关键词

利奈唑胺低钠血症危险因素不良反应列线图模型

Keywords

hyponatremiarisk factoradverse drug reactionnomogram model

references

LIVERMORE D M. Linezolid in vitro：mechanism and antibacterial spectrum[J]. J Antimicrob Chemother，2003，51（Suppl 2）：ii9-ii16.

李娟，吕晓菊.利奈唑胺及其耐药机制研究进展[J].西部医学，2009，21（4）：667-668.

FALAGAS M E，SIEMPOS I I，VARDAKAS K Z. Linezolid versus glycopeptide or beta-lactam for treatment of Gram-positive bacterial infections：meta-analysis of randomised controlled trials[J]. Lancet Infect Dis，2008，8（1）：53-66.

周玥，杨明，赵曜，等.利奈唑胺不良反应研究进展[J].中国药房，2010，21（2）：179-181.

LAWYER M C，LAWYER E Z. Linezolid and reversible myelosuppression[J]. JAMA，2001，286（16）：1974.

刘岩，俞森洋.高龄严重感染患者应用利奈唑胺的疗效及其对血小板的影响[J].中华保健医学杂志，2010，12（3）：198-201.

何鑫，詹亚，张红，等.列线图模型对3 906名血液透析患者透析中低血压发生风险的预测及评估[J].中国血液净化，2022，21（5）：350-355.

KIM Y S，KIM D W，JUNG K H，et al. Frequency of and risk factors for oxcarbazepine-induced severe and symptomatic hyponatremia[J]. Seizure，2014，23（3）：208-212.

国家食品药品监督管理局药品安全监管司，国家药品不良反应监测中心.药品不良反应报告和监测工作手册[EB/OL].[2022-01-15]. https：//max.book118.com/html/2021/0822/5122024000003340.shtmhttps://max.book118.com/html/2021/0822/5122024000003340.shtm.

TANAKA R，SUZUKI Y，MORINAGA Y，et al. A retro- spective test for a possible relationship between linezolid-induced thrombocytopenia and hyponatraemia[J]. J Clin Pharm Ther，2021，46（2）：343-351.

NISHI Y，OGAMI C，TSUJI Y，et al. Evaluation of the relationship between linezolid exposure and hyponatremia[J]. J Infect Chemother，2021，27（2）：165-171.

IOANNOU P，STAVROULAKI M，MAVRIKAKI V， et al. A case of severe hyponatremia due to linezolid-induced SIADH[J]. J Clin Pharm Ther，2018，43（3）：434-436.

BAIK S H，CHOI Y K，KIM H S，et al. A probable case of syndrome of inappropriate antidiuretic hormone secretion associated with linezolid[J]. Am J Health Syst Pharm，2015，72（21）：1865-1869.

LIAMIS G，MILIONIS H，ELISAF M. A review of drug-induced hyponatremia[J]. Am J Kidney Dis，2008，52（1）：144-153.

SUZUKI K，OHISHI K，INO K，et al. Marked hyponatremia with consciousness disturbance probably caused by linezolid in a patient with acute myeloid leukemia[J]. Kansenshogaku Zasshi，2008，82（1）：38-42.

SLATTER J G，STALKER D J，FEENSTRA K L，et al. Pharmacokinetics，metabolism，and excretion of linezolid following an oral dose of [（14）C]linezolid to healthy human subjects[J]. Drug Metab Dispos，2001，29（8）：1136-1145.

MACGOWAN A P. Pharmacokinetic and pharmacodynamic profile of linezolid in healthy volunteers and patients with Gram-positive infections[J]. J Antimicrob Chemother，2003，51（Suppl 2）：ii17-ii25.

WICHA S G，FREY O R，ROEHR A C，et al. Linezolid in liver failure：exploring the value of the maximal liver function capacity （LiMAx） test in a pharmacokinetic pilot study[J]. Int J Antimicrob Agents，2017，50（4）：557-563.

SASAKI T，TAKANE H，OGAWA K，et al. Population pharmacokinetic and pharmacodynamic analysis of linezolid and a hematologic side effect，thrombocytopenia，in Japanese patients[J]. Antimicrob Agents Chemother，2011，55（5）：1867-1873.

ZHANG S H，ZHU Z Y，CHEN Z，et al. Population pharmacokinetics and dosage optimization of linezolid in patients with liver dysfunction[J]. Antimicrob Agents Chemother，2020，64（6）：e00133-e00120.

陈建丽.肝炎肝硬化患者的肝功能检测结果分析及其临床指导价值[J].吉林医学，2022，43（3）：808-810.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

暂无数据