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关节痛是南印度病人对吡嗪酰胺(PZA)治疗最常见的不良反应。但作者观察到在同时服利福平(RFP)的病人中,关节痛的发生率明显降低。已知RFP是肝微粒体酶的诱导剂,影响着许多药物的生物降解。为此,作者研究了RFP对PZA降解的影响及对PZA引起尿酸尿排泄改变的影响。第一项研究是对接受含PZA或PZA+RFP方案每日治疗的结核病人,测定服药后直至11小时的一系列血清PZA和尿酸浓度,以及服药后直至11 1/2小时的尿PZA、吡嗪酸和尿酸浓度。第二项研究是对6例健康志愿者测定24小时中RFP、PZA单纯剂量及两药联合对肾清除尿酸的作用。第一项研究结果表明,在服PZA加或不加服RFP的病人中,PZA的血清浓度和肾清除率相同,提示RFP对PZA的代谢和排泄没有影响。两项研究均显示单服PZA肾脏对尿酸和吡嗪酸的排泄比服PZA和RFP的明显减少,表明尿酸的肾脏排泄受到PZA的抑制。两项研究还证实,在有或者没有PZA的情况下,RFP
Arthralgia is the most common adverse reaction to pyrazinamide (PZA) treatment in South Indian patients. However, the authors observed a significant reduction in the incidence of joint pain in patients taking rifampicin (RFP) at the same time. RFP is known to be an inducer of liver microsomal enzymes and affects the biodegradation of many drugs. To this end, the authors studied the effect of RFP on PZA degradation and the effect of PZA on uric acid excretion. In the first study, a series of serum PZA and uric acid concentrations up to 11 hours post-dose and urinary PZA up to 11 1/2 hours post-dose were measured in patients receiving daily treatment with either PZA or PZA + RFP regimens Zinc acid and uric acid concentrations. The second study was performed on six healthy volunteers to determine the effect of RFP and PZA alone on renal clearance of uric acid in 24 hours. The first study showed that in patients with or without PZA plus PZA, the serum concentration and renal clearance were the same, suggesting that RFP has no effect on PZA metabolism and excretion. Both studies showed that the excretion of uric acid and pyrazinic acid by single kidney PZA was significantly lower than that of PZA and RFP, indicating that renal excretion of uric acid was inhibited by PZA. Two studies also confirmed that with or without PZA, RFP