【作者】 郑晓媛； 张恩娟； 张喆；

【Author】 ZHENG Xiao-yuan,ZHANG En-juan,ZHANG Zhe.Department of Pharmacy,Xinqiao Hospital,Third Military Medical University,Chongqing 400037,China

【机构】 第三军医大学新桥医院药剂科；

【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(PT)112.7 s,国际标准化比值(INR)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、腺苷蛋氨酸、前列地尔、香丹注射液。第8天患者出现昏迷,加强支持治疗,输注新鲜冰冻血浆、冷沉淀并行血浆置换术。第11天患者苏醒,继续对症支持治疗。1个月后实验室复查:ALT 25 U/L,AST 64U/L,白蛋白39.4 g/L,TBiL 65.8μmol/L,DBiL 40.2μmol/L,γ-GT 238 IU/L。患者病情稳定出院。更多还原

【Abstract】 A 25-year-old girl with intestinal and lung tuberculosis received isoniazid(H) 0.3g po.qd,rifampicin(R) 0.45g po.qd, pyrazinamide(Z) 3g po biw,ethambutol(E) 0.75g po qd for her upper pulmonary and intestinal tuberculosis.After drug administration,she developed hepatic disfunction on days 3,acute hepatic failure with hepatic encephalopathyon days 6.Laboratory examination:alanine aminotransferase (ALT) 519 U/L,aspartate transaminase(AST) 1854 U/L,albumin 29.6 g/L, total bilirubin(TBiL)89.9μmol/L,direct bilirubin(DBiL) 59.2μmol/L, prothrombin time(PT) 112.7 s,international normalized ratio(INR) 9.18, D-dimer 0.8 mg/L.We withdrawed all of antitubercular agents,and prescribed a complex regimen using polyene phosphatidyl choline,reduced glutathione,ademetionine,alprostadil,xiangdan injection.She comaed on days 8,consequently support treatment was strengthened by plasma exchange with infusion of fresh frozen plasma and infusion of cryoprecipitate.On days 11,she revived and support treatment was continued.After one month hepatoprotection therapy,Laboratory examination:ALT 25 U/L,AST 64 U/L, albumin 39.4 g/L,TBiL 65.8μmol/L,DBiL 40.2μmol/L,γ-GT 238 IU/L. she recoverd and discharged.更多还原