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HERALD OF MEDICINE, 2018, 37(1): 127-128
doi: 10.3870/j.issn.1004-0781.2018.01.035
利奈唑胺致视力损害的文献分析
孙吉, 张顺芝, 刘晓慧, 吴昭君, 黄娟娟, 陈恒, 何鸽飞

摘要:

目的 调查国内外文献中利奈唑胺致视力损害的不良反应发生情况,分析其临床特点。方法 收集2000—2016年中外医学文献中利奈唑胺致视力损害的病例报告,对患者的年龄、用药情况、不良反应发生的时间和临床特点及转归进行分析。结果 共有11篇个案报道文献纳入统计,涉及利奈唑胺致视力损害患者12例。其中75%患者使用时间超过28 d。结论 利奈唑胺致视力损害的不良反应应引起临床的高度重视,早期发现并给予对症治疗,将其损害降至最低。

关键词: 利奈唑胺 ; 视力损害 ; 不良反应

Abstract:

利奈唑胺主要用于耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、耐青霉素肺炎双球菌引起的肺部感染、菌血症、皮肤软组织感染等,也可作为诺卡尔菌感染、多重耐药结核及其他分支杆菌感染的替代治疗。利奈唑胺最常见的不良事件为腹泻、头痛及恶心,但是也有骨髓抑制、乳酸性酸中毒及神经病变等报道。近年来,随着利奈唑胺的应用逐渐增多,其导致的不良反应患者也逐渐增多。笔者检索国内外文献,深入了解利奈唑胺致视力损害这一不良反应的临床特征,为临床合理用药提供参考。

1 方法
1.1 资料来源

选择Pubmed数据库、Elsevier数据库、Medline数据库(2000—2016年)、CNKI数据库、万方数据库2000—2016年,以利奈唑胺(linezolid)、不良反应(adverse reaction)、视力损害(visual impairment)等为关键词,检出相关文献,并查阅全文,排除综述及重复案例,将明确利奈唑胺致视力损害的案例报道纳入本文。

1.2 统计学方法

利用Excel统计性别、年龄、合并用药、出现不良反应时间、视力损害的表现、疾病转归等患者信息。

2 结果
2.1 一般情况

上述资料来源共计检索到42篇文献,排除不相关、重复及综述等文章,共纳入11篇文献[1-11],共收集12例个案报道。所检索到文献均在2003年以后发表,其中国内暂未发现有利奈唑胺致视力损害的报道。其中男8例,女4例,年龄最小6个月,最大71岁,具体见表1。

表1 利奈唑胺致视力损害患者的年龄、性别情况 例
年龄/岁 合计
0~18 2 0 2
>18~45 3 2 5
>45~70 3 1 4
>70~71 0 1 1

表1 利奈唑胺致视力损害患者的年龄、性别情况 例

2.2 出现不良反应的时间

大部分的文献报道均是长期用药后才导致视力损害,有3例患者用药<28 d出现视力损害。其中1例在用药后第3天就出现视力下降。使用90~180 d出现视力损害4例;使用180~300 d出现视力损害3例,使用>300 d出现视力损害2例。

2.3 联合药物

在检索的文献当中,仅有4例存在联合药物,其中有2例使用利奈唑胺联合乙胺丁醇治疗耐药结核,有1例同时使用利奈唑胺、莫西沙星、吡嗪酰胺,有1例同时使用利奈唑胺与甲硝唑,其余病例仅使用了利奈唑胺。所有联合用药方案的病例中,均排除了其他药物致视力损害的可疑性。

2.4 利奈唑胺致视力损害的临床表现

所有患者均出现不同程度视力下降,两眼视力受损的程度不同,但是其中仅2例出现单纯的视力下降,无其他伴发症状。有个别案例出现视觉受损、感觉异常。其余的病例除了视力下降外,还出现了色觉受损、双眼有中心盲点等症状。

2.5 治疗和转归

所有患者均在停药后有一定程度的好转,8例视力恢复,4例视力好转。

3 讨论

通过文献研究发现,利奈唑胺致视力损害与年龄无关,利奈唑胺致视力损害的案例年龄分布广,有婴幼儿、中青年、老年人等,但是通过比较发现,有60%~70%患者是长期使用利奈唑胺后而发生视力损害。

目前对于利奈唑胺导致视力损害的机制尚不清楚,但有研究者认为其可能与营养不良所致的视神经病变的机制类似[11-12]。在长期使用利奈唑胺时,如使用时间>28 d,医务工作者要特别注意患者视力的变化,警惕视力损害等不良反应的发生。最好能在治疗之前进行一个基本的眼科检查,眼科医生每个月定期进行监测。如果患者出现视力丧失或者视物失去色彩,需立即告知医务人员。患者在使用利奈唑胺后,如果出现视力损害,需要完善相关检查,包括血常规、生化、尿常规,血铅水平的测定(对于同时出现周围神经病变的患者尤其需要检测)、维生素B12、叶酸也同样需要检测,重要的是需立即请眼科专科医生进行会诊,进行全面的眼科检查[13]

The authors have declared that no competing interests exist.

参考文献

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关键词(key words)
利奈唑胺
视力损害
不良反应


作者
孙吉
张顺芝
刘晓慧
吴昭君
黄娟娟
陈恒
何鸽飞