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1例74岁女性患者,因结核性胸膜炎给予链霉素、异烟肼、利福平及吡嗪酰胺。用药1周后出现肝肾损害。停用抗结核药,肝肾功能恢复正常。再次抗结核治疗,出现发热及皮肤瘙痒。停药及抗过敏治疗后症状好转。再次口服异烟肼0.2g,吡嗪酰胺1.0g,乙胺丁醇0.75g。30min后出现畏寒、发热、恶心、呕吐,意识障碍,唇周发绀。T40.5℃,P120次/min。随后出现少尿,颈强直;左侧上、下肢肌力2级,右侧上、下肢肌力0级。实验室检查:ALT41U/L,AST99U/L,BUN13.57mmol/L,SCr481μmol/L;肌红蛋白2470μg/L,肌钙蛋白0.52μg/L,LDH442U/L,α-羟丁酸脱氢酶315U/L,CK2789U/L,CK-MB50U/L,血清淀粉酶384U/L。行对症支持治疗,2d后症状好转。再次给予吡嗪酰胺、乙胺丁醇、左氧氟沙星抗结核治疗,治疗2个月未出现不良反应。
A 74-year-old female patient was given streptomycin, isoniazid, rifampicin, and pyrazinamide for tuberculous pleurisy. Liver and kidney damage after 1 week of treatment. Disable anti-TB drugs, liver and kidney function returned to normal. Anti-TB treatment again, fever and skin itching. After withdrawal and anti-allergy symptoms improved. Oral isoniazid 0.2g again, pyrazinamide 1.0g, ethambutol 0.75g. After 30min chills, fever, nausea, vomiting, disturbance of consciousness, lip cyanosis. T40.5 ℃, P120 times / min. Subsequently there oliguria, neck stiffness; left upper and lower extremity strength 2, the right upper and lower limb muscle strength 0. Laboratory tests: ALT41U / L, AST99U / L, BUN13.57mmol / L, SCr481μmol / L; myoglobin 2470μg / L, troponin 0.52μg / L, LDH442U / L, α-hydroxybutyrate dehydrogenase 315U / L, CK2789U / L, CK-MB50U / L, serum amylase 384U / L. Line symptomatic supportive treatment, 2d after symptoms improved. Once again given pyrazinamide, ethambutol, levofloxacin anti-TB treatment, 2 months of treatment did not appear adverse reactions.