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Received:September 03, 2025 Published Online:May 22, 2026
Received:September 03, 2025 Published Online:May 22, 2026
中文摘要: 目的 探讨重症感染患者使用替加环素发生高胆红素血症（HB）的危险因素，为临床安全合理使用该药提供参考依据。方法 回顾性收集2018年1月至2024年12月苏州市立医院收治的205例接受替加环素治疗的重症感染患者的临床资料，根据治疗后是否发生HB分为HB组（n=40）和非HB组（n=165）。收集两组患者的一般资料、感染相关诊断、基础疾病史、替加环素用药情况及实验室检查指标等，采用多因素logistic回归分析危险因素；绘制受试者工作特征（ROC）曲线，以曲线下面积（AUC）评估各独立危险因素联合预测 HB 发生的效能。结果 205例患者中，HB发生率为19.5%（40/205）。单因素分析显示，两组在合并基础疾病（肾脏疾病、肝脏疾病），超敏C-反应蛋白（hs-CRP），降钙素原（PCT）、血小板计数（PLT）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、天冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）及白蛋白水平上差异有统计学意义（P＜0.05）；多因素logistic回归分析显示，合并肝脏疾病（OR =3.817，95%CI：1.467~9.933）、APTT升高（OR =1.084，95%CI：1.028~1.142）、PCT升高（OR =1.093，95%CI：1.021~1.170）和PLT降低（OR =0.994，95%CI：0.989~0.999）是发生替加环素相关性HB的独立危险因素（P＜0.05）。ROC曲线分析结果显示，APTT、PCT及PLT 3项指标联合预测HB发生的AUC最高，为0.867（95%CI：0.800~0.934），灵敏度为77.5%，特异度为84.2%。结论 合并肝脏疾病、APTT延长、PCT升高及PLT降低是重症感染患者使用替加环素后发生HB的高危因素。临床应用替加环素抗感染治疗时，需高度警惕此类高危患者的HB发生风险，加强相关指标监测，以降低不良反应的发生。
Abstract:Objective To investigate the risk factors for hyperbilirubinemia（HB）in critically infected patients treated with tigecycline，thereby providing a reference for the safe and rational clinical use of this drug. Methods A retrospective review was conducted on 205 critically infected patients who received tigecycline in Suzhou Municipal Hospital from January 2018 to December 2024. Patients were stratified into an HB（n=40）group and non-HB（n=165）group based on the occurrence of HB after treatment. General data，clinical histories，tigecycline dosing regimens，and laboratory parameters of the two groups were collected. Risk factors were identified using multivariate logistic regression.Receiver operating characteristic（ROC）curve was plotted，and the area under the curve（AUC）was used to evaluate the value of these factors for predicting HB occurrence. Results The incidence of HB was 19.5%（40/205）. Univariate analysis showed statistically significant differences between the two groups in underlying diseases（renal disease，liver disease），high-sensitivity C-reactive protein（hs-CRP），procalcitonin（PCT），platelet count（PLT），activated partial thromboplastin time（APTT），prothrombin time（PT），aspartate aminotransferase（AST），alanine aminotransferase（ALT），and albumin levels（P＜0.05）. Multivariate logistic regression analysis showed that combined liver disease（OR =3.817，95%CI：1.467-9.933），elevated APTT（OR =1.084，95%CI：1.028-1.142），increased PCT（OR =1.093，95%CI：1.021-1.170）and decreased PLT（OR =0.994，95%CI：0.989-0.999）were independent risk factors for tigecycline-related HB（P＜0.05）. ROC curve analysis showed that the AUC of the combination of APTT，PCT and PLT in predicting HB was 0.867（95%CI：0.800-0.934），with a sensitivity of 77.5% and a specificity of 84.2%. Conclusion Combined liver disease，elevated APTT，elevated PCT，and decreased PLT are high - risk factors for HB in critically infected patients treated with tigecycline. Clinicians should exercise heightened vigilance when tigecycline is used for anti-infective treatment，and enhance monitoring of these parameters in high-risk patients to mitigate the risk of this adverse reaction.
keywords: Tigecycline Hyperbilirubinemia Multidrug resistant bacterial infection Drug-induced liver injury
文章编号： 中图分类号：R978.1+4 R575.5 文献标志码：A
基金项目:苏州市应用基础研究（医疗卫生）科技创新项目（SYWD2024329）
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