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1例75岁男性肺结核患者,口服利福平0.6 g,1次/d;异烟肼0.3 g,1次/d;吡嗪酰胺0.3 g,3次/d;左氧氟沙星0.2 g,2次/d。用药11 d后,患者出现红色斑丘疹,体温最高38℃。用药14 d,因症状加重,自行停药。随后,患者出现皮肤、巩膜黄染,呕吐,水肿,遂入院。实验室检查:丙氨酸转氨酶(ALT)652 U/L,天冬氨酸转氨酶(AST)5066 U/L,碱性磷酸酶(ALP)66 U/L,直接胆红素(DBil)30.9μmol/L,总胆红素(TBil)53.5μmol/L,肌酐(SCr)150.0μmol/L,尿素氮(BUN)13.9 mmol/L,血小板(PLT)65×109/L。入院诊断:继发性肺结核;药物性肝损害;Ⅰ型呼吸衰竭;肾功能不全;心房颤动;多器官功能障碍综合征。停用所有抗结核药物,给予胺碘酮、苯海拉明、葡萄糖酸钙、可的松、腺苷蛋氨酸等对症、支持治疗。入院2周后,患者明显好转。实验室检查ALT 36 U/L,AST 29 U/L,DBil 27.6μmol/L,TBil 45.5μmol/L,PLT 93×109/L,SCr 51.5μmol/L,BUN10.1 mmol/L。重新给予抗结核治疗:乙胺丁醇0.75g,1次/d。1周后,加用吡嗪酰胺0.1 g,3次/d。2周后,加用异烟肼0.3 g,1次/d。入院1个月后,患者病情稳定,出院。
1 case of 75-year-old male with pulmonary tuberculosis, oral rifampin 0.6 g, 1 / d; isoniazid 0.3 g, 1 / d; pyrazinamide 0.3 g, 3 times / d; levofloxacin 0.2 g twice daily . After 11 days of treatment, the patient developed red rash and the maximum temperature was 38 ° C. Medication 14 d, due to aggravating symptoms, self-withdrawal. Subsequently, the patient showed skin, scleral yellow dye, vomiting, edema, then hospitalized. Laboratory tests included 652 U / L of ALT, 5066 U / L of aspartate aminotransferase (ALT), 66 U / L of alkaline phosphatase (ALP), 30.9 μmol of DBil / L, 53.5μmol / L TBIL, 150.0μmol / L SCr, 13.9 mmol / L BUN and 65 × 109 PL / L. Admission diagnosis: secondary pulmonary tuberculosis; drug-induced liver damage; type I respiratory failure; renal insufficiency; atrial fibrillation; multiple organ dysfunction syndrome. Disable all anti-TB drugs, given amiodarone, diphenhydramine, calcium gluconate, cortisone, adenosine methionine symptomatic and supportive treatment. Two weeks after admission, the patient improved significantly. Laboratory tests showed ALT 36 U / L, AST 29 U / L, DBil 27.6 μmol / L, TBil 45.5 μmol / L, PLT 93 × 109 / L, SCr 51.5 μmol / L and BUN 10.1 mmol / L. Re-given anti-TB treatment: ethambutol 0.75g, 1 time / d. After 1 week, plus pyrazinamide 0.1 g, 3 times / d. After 2 weeks, plus isoniazid 0.3 g, 1 time / d. One month after admission, the patient was stable and discharged.