利福平诱发药源性血小板减少症分析

Analysis of Rifampicin Induced Thrombocytopenia

1例36 a女性拟诊结核病患者给予经典的四联口服抗结核药物"异烟肼","乙胺丁醇","吡嗪酰胺","利福平"治疗。入院前已服用该4种药物10 d,入院检查血常规示WBC 7.64×109/L,N%65.7%,Hb 121 g/L,PLT 174×109/L、肝肾功能、出凝血常规等无异常。入院后续给予口服四联抗结核药物,同时给予止咳祛痰药物对症治疗。入院第5天出现四肢皮肤散在出血点,偶见瘀斑。急查血象示WBC 4.96×109/L,N%62.8%,Hb125 g/L,PLT 31.7×109/L,肝功:ALT 61 U/L,AST 49 U/L。给予护肝治疗,停用利福平,改用链霉素,余抗结核药物不变。但血小板持续下降,复查PLT11.9×109/L。给予输注血小板,激素冲击治疗3 d,血小板逐渐回升,复查为56.8×109/L、93.4×109/L、110×109/L。第11天出院时PLT 153×109/L,肝肾功能无异常,四肢及腹部皮肤原有出血点消退,影像学示病灶明显减小,抗结核治疗有效,带药出院继续治疗。

A 36-year-old female patient suspected tuberculosis was remedy by classical quadruple oral anti-tuberculosis drugs such as ＂isoniazid,ethambutol,pyrazinamide,rifampicin＂.The patient have taken the 4 drugs for 10 d prior to admission,the admission check include routine blood show WBC 7.64×10^9/L,N% 65.7%,Hb 121g/L,PLT 174×10^9/L,such as liver and kidney function and blood coagulation routine without exception.Subsequent admission to give oral 4 anti-tuberculosis drugs,and at the same time give symptomatic approach antitussive and expectorant.Admission day 5 the patient was seen bleeder limb skin,accidentally seen ecchymosis.Quick-checked blood routine shown WBC 4.96×10^9/L,N% 62.8%,Hb 125 g/L,PLT 31.7×10^9/L,liver meritorious service was： ALT 61 U/L,AST49 U/L.The patient was given liver protect treatment,rifampicin was stopped,and was switched to streptomycin,the other antituberculostic drugs remained the same.Platelet of the patient continued to decline,reviewed PLT was 11.9×10^9/L.Then the patient was treated by intravenous drip of the platelet,hormone shock therapy for 3 d,and his platelet recovered gradually,reviewed results showed 56.8×10^9/L,93.4×10^9/L,110×10^9/L.11th day at recover,PLT of the patient was 153×10^9/L,no abnormal liver and kidney function,limbs and abdomen skin original bleeder fade,image of lesions decreased obviously.The anti-tuberculosis treatment was effective,medicine was took out of the hospital to continue the treatment.