抗结核药物致伪膜性肠炎6例并文献复习  

Six cases of pseudomembranous colitis caused by anti-tuberculosis drugs and literature review

作　　者：葛静 王隽[2] 何玉琦 聂文娟[2] Ge Jing;Wang Jun;He Yuqi;Nie Wenjuan(Department of Infectious Disease,Hami Central Hospital,Hami 839000,China;The First Department of Tuberculosis,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China;The Digestive Endoscopy Department,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]哈密市中心医院感染科,哈密839000 [2]首都医科大学附属北京胸科医院结核一科,北京101149 [3]首都医科大学附属北京胸科医院消化内镜科,北京101149

出　　处：《中国防痨杂志》2024年第11期1320-1326,共7页Chinese Journal of Antituberculosis

基　　金：临床医学发展专项“扬帆”计划项目(ZLRK202331)。

摘　　要：目的:报道6例抗结核药物致伪膜性肠炎(PMC)患者临床诊治过程,并结合文献分析致病机制、临床特点、治疗及预后。方法:收集2022年5月至2024年3月首都医科大学附属北京胸科医院收治的6例抗结核治疗后出现腹泻,肠镜检查后明确为PMC患者的临床一般资料(包括临床起病、粪便形状及相关伴随症状等)、实验室检查结果(包括粪便常规、粪便培养)、内镜检查、病理结果、最终诊断、治疗过程及预后;以1990年1月至2020年5月为检索时间,从PubMed数据库中以“tuberculosis+Clostridium difficile”和“tuberculosis+pseudomembranous”为检索词,从万方数据库中以“结核+伪膜性肠炎”和“结核+假膜性肠炎”为检索词,检索到符合入组标准的使用抗结核药物后出现PMC的6篇文献、99例患者,总结本组患者特征并进行入选患者文献复习。结果:6例患者中,5例肺结核,1例鸟分枝杆菌病;均在使用含利福平和乙胺丁醇抗结核治疗方案治疗约2~30d后出现腹泻、腹部隐痛及胀痛;粪便艰难梭菌培养均为阴性;肠镜检查均可见结肠黏膜黄白色伪膜覆盖;病理活检均可见黏膜组织急慢性炎;给予停用利福平,使用万古霉素(0.25g/次,4次/d,口服)抗感染、调节肠道菌群、补液抗休克治疗3~5d后症状均明显减轻,症状消失后再次服用抗结核药物,有2例再次出现腹泻症状。文献涉及的99例患者中,97例肺结核、骨结核和结核性脑膜炎各1例,均在使用异烟肼、利福平、吡嗪酰胺等抗结核药物9~120d内出现不同程度的腹泻、腹痛,肠镜下均可见黏膜充血水肿伴白色伪膜样表现,均经肠镜及粪便检查后确诊,有29例患者艰难梭菌毒素检测阳性,均在给予万古霉素抗感染(其中10例患者使用甲硝唑)、益生菌调节肠道菌群后症状好转,包括3例复发患者。结论:长期使用含利福霉素类抗结核药物需警惕PMC的发生,尤其是对高龄、使用糖皮质激�Objective:To report the clinical diagnosis and treatment process of 6 patients with pseudomembranous colitis(PMC)caused by anti-tuberculosis drugs,and to analyze the pathogenic mechanism,clinical characteristics,treatment,and prognosis in combination with literature.Methods:Six cases of diarrhea after anti-tuberculosis treatment confirmed as PMC by colonoscopy examination were reported from May 2022 to March 2024 at Beijing Chest Hospital Affiliated to Capital Medical University.Clinical information(including clinical onset,stool shape,and related accompanying symptoms),laboratory examination results(including stool routine examination,stool culture),endoscopic examination,pathological examination results,final diagnosis,treatment process,and prognosis were analyzed.Six articles and 99 patients with PMC after using anti-tuberculosis drugs were retrieved through searching studies published from January 1990 to May 2020 in the PubMed database using“tuberculosis+Clostridium difficile”and“tuberculosis+pseudomembranous colitis”as search terms,and the Wanfang database using“tuberculosis+pseudomembranous colitis”and“tuberculosis+pseudomembranous colitis”as search terms.The characteristics of patients in this group were summarized and literature review was conducted for selected patients.Results:Among the 6 patients,5 had pulmonary tuberculosis and 1 had Mycobacterial avium disease.All cases occurred diarrhea,abdominal pain and bloating after anti-tuberculosis treatment containing rifampicin and ethambutol for about 2-30 days.Clostridium difficile examination in stool was negative.Colonoscopy examination showed a yellow white pseudomembrane covered with the colon mucosa.Pathological biopsy showed acute and chronic inflammation of mucosal tissue.After discontinuing rifampicin,using vancomycin(0.25 g/time,4 times/day,orally)for anti infection,regulating gut microbiota,and fluid replacement to treat shock for 3-5 days,the symptoms significantly improved.When the symptoms disappeared and anti tuberculosis dru

关 键 词：结核 药物疗法 利福平 不良反应 小肠结肠炎 伪膜性 疾病特征 

分 类 号：R574[医药卫生—消化系统]