【作者】 方勇； 肖和平； 唐神结； 梁莉；

【Author】 Tongji University Affliated Shanghai Pulmonary Hospital,Shanghai Tuberculosis(Lung) Key Laboratory,Shanghai 200433,China FANG yong XIAO he-ping TANG shen-jie LIANG li

【机构】 上海市肺科医院结核科；

【摘要】 目的探讨抗结核药物引起药物热的临床特点及处理措施。方法收集2006年4月至2010年3月在我院门诊或住院期间确诊为肺结核或肺外结核并接受抗结核治疗的78例患者临床资料,对抗结核药引起药物热进行分析。结果抗结核药引起药物热以利福平最多见,其次为对氨基水杨酸和吡嗪酰胺,发生时间均发生在抗痨后2个月以内,主要集中在用药后1～3周。药物热以39℃以上高热为主。伴随症状主要有皮疹、畏寒和寒战、头痛、鼻塞流涕、恶心呕吐和关节痛。行血常规检的查患者中,嗜酸性粒细胞增高有15例,降低15例,正常者38例,63例患者行肝功能检查,肝功能异常10例,肝功能损害4例。怀疑有药物热存在时,都先采取了停药的处理方法,其中59例患者全部停药,19例采取了逐步停药。有合并症的患者均先按照合并症处理原则处理,恢复正常后再逐步试药;无合并症的患者热退后,即开始试药;试药方法均按照致热可能性由小到大逐一从小剂量开始试用。本组患者基本上在停药后在24～48小时内,发热即可退去。结论药物热是一种超敏反应,有其特点和规律可循,应从伴或不伴有肝损或皮疹等4个方面来处理。更多还原

【Abstract】 Objective To analyze the clinical features of anti-tuberculosis drugs-induced fever and the methods to deal with it.Methods 78 in-patients and outpatients with pulmonary tuberculosis accompanied by the drug fever during the anti-tuberculosis treatment were analyzed retrospectively from April 2006 to March 2010.Results Among the anti-tuberculosis drugs that caused the drug fever,Rifampicin is the most common one, followed by para-aminosalicylic and pyrazinamide.The symptoms occurred within 2 months after treatment, mainly happened in 1 to 3 weeks after therapy.The body temperature was mainly above 39 degrees Celsius.The accompanied symptoms were rash,chills,headache,stuffy nose,runny nose,nausea,vomiting and joint pain.70 patients underwent blood routine examination,increased eosinophilia in 15 cases,lower in 15 cases,38 cases of normal.63 patients underwent liver function tests,abnormalities of liver function in 10 cases,4 cases of liver damage. When the drug fever was suspected,the measure of withdrawal was taken first.All the suspected drugs were withdrawn for 59 cases.We took gradual withdrawal for 19 cases.The patients with complications were first treated in accordance with the principles of complications treatment and then gradually tried some drugs after recovery.The patients without complications were gradually tried some drugs after the body temperature was back to normal.The medicine was tested in accordance with the possibility of leading to fever from small to large,beginning with small dose.The body temperature returned to normal mainly within 24～48 hours after withdrawal.Conclusion The drug fever is an allergic reaction.The resolution of the drug fever depends on whether accompanied by hepatitis and/or rash or not.更多还原