肝移植受者围手术期应用替加环素预防感染的效果及低纤维蛋白原血症发生情况

徐静; 赵圆圆; 陈知水; 杨博; 陈栋; 魏来

doi:10.3969/j.issn.1674-7445.2023.02.010

肝移植受者围手术期应用替加环素预防感染的效果及低纤维蛋白原血症发生情况

doi: 10.3969/j.issn.1674-7445.2023.02.010

430030 武汉，华中科技大学同济医学院附属同济医院器官移植研究所器官移植教育部重点实验室国家卫生健康委员会器官移植重点实验室中国医学科学院器官移植重点实验室

基金项目:

湖北省重点研发计划项目 2022BCA015

详细信息

作者简介:

通讯作者:
魏来，博士，主任医师，研究方向为肝移植Email：weilai@tjh.tjmu.edu.cn

中图分类号: R617, R978.1
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出版历程
- 收稿日期: 2022-10-31
- 网络出版日期: 2023-03-15
- 刊出日期: 2023-03-15

Efficacy of perioperative use of tigecycline in preventing infection and incidence of hypofibrinogenemia in liver transplant recipients

Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation of Ministry of Education, Key Laboratory of Organ Transplantation of National Health Commission of China, Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences, Wuhan 430030, China

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Corresponding author: Wei Lai, Email: weilai@tjh.tjmu.edu.cn

摘要

摘要: 目的探讨肝移植受者围手术期使用替加环素预防感染的效果及低纤维蛋白原血症发生情况。方法回顾性分析40例使用替加环素进行预防感染的肝移植受者的临床资料，分析受者感染事件和供者来源感染事件发生情况；分析替加环素治疗时、结束时及治疗结束后（7±2）d受者临床指标变化情况；总结低纤维蛋白原血症的发生及治疗情况。结果 40例肝移植受者中，2例受者发生感染，分别为黑曲霉和巨细胞病毒感染，均不属于替加环素抗菌谱所覆盖的范围，调整抗感染方案后感染情况控制良好。9例供肝相关培养阳性，但均未发展为供者来源性感染事件。40例受者均于术后2周左右肝功能恢复良好出院，其中6例于术后2~4 d出现低纤维蛋白原血症伴凝血功能障碍，而转氨酶、胆红素、感染相关指标术后逐步下降，白蛋白水平稳定，予以补充人纤维蛋白原及凝血酶原复合物，凝血功能好转，但纤维蛋白原水平持续下降。停用替加环素后，纤维蛋白原水平逐渐恢复至正常，考虑可能为替加环素相关药物不良反应。结论肝移植受者围手术期使用包含替加环素在内的预防感染方案可以降低敏感细菌导致的感染发生率，但药物使用期间需密切关注低纤维蛋白原血症的发生。
- 肝移植 /
- 感染 /
- 替加环素 /
- 低纤维蛋白原血症 /
- 药物不良反应 /
- 多重耐药菌 /
- 供者来源性感染 /
- 凝血功能障碍
Abstract: Objective To evaluate the efficacy of perioperative use of tigecycline in preventing infection and the incidence of hypofibrinogenemia in liver transplant recipients. Methods Clinical data of 40 liver transplant recipients given with tigecycline to prevent infection were retrospectively analyzed. The incidence of infection in recipients and donor-derived infection were analyzed. The changes of clinical indexes in recipients during, upon the completion and (7±2) d after tigecycline treatment were analyzed, respectively. The incidence and treatment of hypofibrinogenemia were summarized. Results Among 40 liver transplant recipients, 2 cases were infected by aspergillus niger and cytomegalovirus, out of the antibacterial spectrum of tigecycline. After adjusting the anti-infection regimen, the infection was properly controlled. Liver allografts were positive for relevant culture in 9 cases, whereas none of them progressed into donor-derived infection. Approximately at postoperative 2 weeks, all 40 recipients restored liver function and were discharged from hospital. Among them, 6 recipients developed hypofibrinogenemia complicated with coagulation disorder at postoperative 2-4 d, whereas transaminase level, bilirubin level and infection-related indexes were gradually decreased after liver transplantation, and albumin level was stable. After supplemented with human fibrinogen and prothrombin complex, coagulation function was improved, but fibrinogen level persistently declined. After terminating use of tigecycline, fibrinogen level was gradually restored to normal range, which might be an adverse drug reaction induced by tigecycline. Conclusions Perioperative anti-infection regimen including tigecycline may reduce the incidence of infection caused by sensitive bacteria in liver transplant recipients. Nevertheless, the incidence of hypofibrinogenemia should be intimately monitored throughout the use of tigecycline.
- Liver transplantation /
- Infection /
- Tigecycline /
- Hypofibrinogenemia /
- Adverse drug reaction /
- Multi-drug resistant organism /
- Donor-derived infection /
- Coagulation disorder

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图 1 实验设计图

Figure 1. Experimental design graph

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图 2 40例肝移植受者临床指标变化情况

Figure 2. Changes of clinical data of 40 liver transplant recipients

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表 1 使用替加环素后出现低纤维蛋白原血症的6例受者的特点及治疗信息

Table 1. Characteristics and treatment information of 6 liver transplant recipients with hypofibrinogenemia after using tigecycline

					FIB水平（g/L）
例序	年龄（岁）	原发病	透析情况	替加环素治疗时间（d）	基础值	D0	Df	Df+7	低纤维蛋白原血症出现时间（d）^①	停药后FIB恢复时间（d）
1	69	乙肝肝硬化伴原发性肝癌	否	6	0.89	1.63	1.49	2.73	3	5
2	47	乙肝肝硬化	是^②	6	0.95	1.79	0.50	2.14	2	6
3	34	乙肝肝硬化	否	6	1.79	2.96	0.90	4.28	3	3
4	58	丙肝肝硬化	否	8	2.15	2.13	1.07	4.40	3	3
5	54	乙肝肝硬化	否	4	2.75	1.69	0.62	3.40	3	4
6	46	自身免疫性肝炎肝硬化	否	7	3.37	2.24	1.72	3.40	4	3
注：①为使用替加环素后。 ②肾衰竭被定义为血清肌酐水平 > 3倍基础值或≥354 μmol/L，尿量 < 0.3 mL/（kg·d）持续24 h以上或无尿持续12 h。例2受者肝移植术后血清肌酐 > 3倍基础值，行连续性肾脏替代治疗4次。

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