HRZE方案抗结核治疗致急性肝衰竭和肝性脑病  

Acute hepatic failure and hepatic encephalopathy after receiving a HRZE antitubercular regimen

作　　者：郑晓媛[1] 张恩娟[1] 张喆[1] 

机构地区：[1]第三军医大学新桥医院药剂科,重庆400037

出　　处：《药物不良反应杂志》2013年第2期109-111,共3页Adverse Drug Reactions Journal

摘　　要：1例25岁女性肺结核并肠结核患者应用HRZE方案化疗,即口服异烟肼(H)0.3 g,1次/d;利福平(R)0.45 g,1次/d;吡嗪酰胺(Z)3 g,1次/3 d;乙胺丁醇(E)0.75 g,1次/d。服药3 d后出现肝功能损害,6 d后出现急性肝衰竭伴肝性脑病。实验室检查:丙氨酸转氨酶(ALT)519 U/L,天冬氨酸转氨酶(AST)1854 U/L,白蛋白29.6 g/L,总胆红素(TBil)89.9μmol/L,直接胆红素(DBil)59.2μmol/L,凝血酶原时间113 s,国际标准化比值9.18,D-二聚体0.8 mg/L。立即停用所有抗结核药物,给予多烯磷脂酰胆碱、还原型谷胱甘肽、丁二磺酸腺苷蛋氨酸、前列地尔、香丹注射液。第9天患者出现昏迷,加用果糖二磷酸钠、甘露醇;行血浆置换术;输注新鲜冰冻血浆、冷沉淀。第11天患者苏醒,继续支持治疗。1个月后复查:ALT 25 U/L,AST 64 U/L,白蛋白39.4 g/L,TBil 65.8μmol/L,DBil 40.2μmol/L。A 25-year-old female patient with pulmonary and intestinal tuberculosis received a HRZE antitubereular regimen comprising isoniazid （ H ） 0.3 g once daily, rifampicin （ R ） 0.45 g once daily,pyrazinamide （Z） 3 g once every three days, ethambutol （E） 0.75 g once daily. Three days later, she developed hepatic dysfunction. Six days later, she developed acute hepatic failure with hepatic encephalopathy. Laboratory tests showed the following values： alanine aminotransferase （ALT） 519 U/L, aspartate transaminase （AST） 1854 U/L, albumin 29.6 g/L, total bilirubin （TBil） 89.9 Ixmol/L, direct bilirubin （DBil） 59.2 μmol/L, prothrombin time 113 s, international normalized ratio 9.18, D-dimer 0.8 mg/L. All antitubercular agents were stopped, polyene phosphatidyl choline, reduced glutathione, ademetionine 1,4-butanedisulfonate, alprostadil, Xiangdan injection （香丹注射液） were given. On day 9, she presented with coma, fructose sodium diphosphate and mannitol were added to her regimen. She received plasma exchange and transfusions of fresh frozen plasma and cryoprecipitate. On day 11, she revived and supportive therapy was continued. One month later, repeat testing showed the following results： ALT 25 U/ L, AST 64 U/L, albumin 39.4 g/L, TBil 65.8 μmol/L, DBil 40.2 μmol/L.

关 键 词：异烟肼 利福平 吡嗪酰胺 乙胺丁醇 肝功能衰竭 急性 肝性脑病 

分 类 号：R595.3[医药卫生—内科学]