四联抗结核治疗致血小板减少脑出血死亡1例并文献复习  

A case of thrombocytopenia caused by tetrad antituberculosis died from cerebral hemorrhage and literature review

作　　者：刘洋[1] 李可 李科苇 LIU Yang;LI Ke;LI Kewei(Department of Emergency,Mianyang Central Hospital,621000,China)

机构地区：[1]绵阳市中心医院急诊科,621000

出　　处：《传染病信息》2024年第2期182-184,188,共4页Infectious Disease Information

基　　金：2019年四川省卫健委科研课题(普及应用项目)(19PJ113);2020年度绵阳市中心医院院级课题立项(2020YJ04)。

摘　　要：结核病治疗时间长,抗结核药物因联合用药、药物种类多样,服药周期长,在治疗过程中可能出现累及各个系统、不同程度、多种药物不良反应。其中血液系统异常较为常见,临床发现使用抗结核药物治疗后出现血小板减少者较多,可引起患者出血风险增大,严重时可出现重要脏器出血而危及生命。本文就1例使用四联抗结核治疗(利福平、吡嗪酰胺、乙胺丁醇、异烟肼)过程中出现血小板重度减少,并发严重脑出血死亡的病例进行报道并结合文献复习,对该类患者的治疗进行探讨,以警示临床医师重视抗结核药物导致的血小板减少症,确保患者用药安全。Tuberculosis treatment is a protracted process that often necessitates the combined use of multiple anti-tuberculosis drugs over an extended period.This prolonged and complex treatment regimen can give rise to a range of adverse drug reactions that may affect various bodily systems and differ in severity.Notably,hematological abnormalities are among the more prevalent side effects observed.Clinical data indicates a significant incidence of thrombocytopenia following the administration of anti-tuberculosis medications,elevating the risk of bleeding in patients.In extreme cases,bleeding in crucial organs can pose a grave threat to life.Herein,we detail a fatal instance of profound thrombocytopenia,complicated by severe cerebral hemorrhage,that arose during a quadruplex anti-tuberculosis treatment course comprising rifampicin,pyrazinamide,ethambutol,and isoniazid.Furthermore,we undertake a review of pertinent literature and delve into potential treatment strategies for such cases,with the ultimate goal of emphasizing the critical need for clinicians to closely monitor thrombocytopenia induced by anti-tuberculosis drugs and prioritize patient safety throughout the course of medication.

关 键 词：抗结核 血小板减少 紫癜 出血 

分 类 号：R978.3[医药卫生—药品]