抗结核药物引起的艰难梭状芽胞杆菌相关性腹泻一例并文献复习  

Clostridium difficile-associated diarrhea caused by anti-tuberculosis drugs:a case report and literature review

作　　者：王静[1] 张蒙[1] 贺建清[1] WANG Jing;ZHANG Meng;HE Jian-qing(Department of Respiratory and Critical Care Medicine West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院呼吸与危重症医学科,成都610041

出　　处：《中国防痨杂志》2020年第3期293-296,共4页Chinese Journal of Antituberculosis

基　　金：国家自然科学基金(81870015)。

摘　　要：抗生素的使用是发生艰难梭状芽胞杆菌相关性腹泻的危险因素,而其中抗结核药物的使用则很少被报道与之相关。作者报告了1例与抗结核药物治疗相关的艰难梭状芽胞杆菌相关性腹泻患者,并搜集相关文献进行复习。患者为女性,32岁,罹患肺结核已行抗结核药物治疗9个月。因腹痛、腹泻入院治疗,通过艰难梭状芽胞杆菌毒素及谷氨酸脱氢酶检测呈阳性确诊。在停用抗结核药物,以及接受万古霉素和双歧杆菌乳杆菌三联活菌片(金双歧)治疗9d后症状缓解。作者通过复习相关文献,讨论了艰难梭状芽胞杆菌相关性腹泻的发病机制、临床表现、诊断和治疗方法,提醒临床医生了解结核病治疗过程中的罕见并发症,尽早确诊并采取必要的干预措施。Antimicrobial agent exposure is a risk factor for Clostridium difficile associated diarrhea(CDAD),whereas the use of anti-tuberculous(anti-TB)drugs is rarely associated with it.This article reports a case of CDAD associated with anti-TB drugs,and reviews relevant literatures.A 32-year-old woman with pulmonary tuberculosis who had been treated with anti-TB agents for 9 months was admitted for abdominal pain and diarrhea.The test results of Clostridium difficile toxin and glutamate dehydrogenase(GHD)were both positive.Symptoms were relieved after anti-TB drugs were discontinued and treatment with vancomycin and bifidobacterium was given for 9 days.By reviewing literatures,the authors have discussed the pathogenesis,clinical manifestations,diagnosis and treatment of CDAD,in order to remind clinicians to understand the rare complications in the process of tuberculosis treatment,and to avoid pseudomembranous colitis(PMC)and other serious intestinal diseases by early diagnosis and intervention.

关 键 词：结核 肺 抗结核药 芽孢杆菌 腹泻 总结性报告(主题) 

分 类 号：R521[医药卫生—内科学]