左氧氟沙星致严重不良反应一例并文献复习

Severe liver damage caused by levofloxacin and literature review

目的 了解左氧氟沙星导致的严重不良反应的现状及特点.方法 对1例左氧氟沙星导致的严重不良反应患者的诊治经过进行回顾性分析并结合文献进行讨论.结果 患者应用左氧氟沙星第7天,出现恶心、欲吐,食欲差.第8天出现烦躁、心慌、身冷;心率增快,心率148次/min;血糖降低,为3.1 mmol/L;嗜酸粒细胞计数升高,0.5 x109/L;肝功能异常,丙氨酸转氨酶3 111 U/L,天冬氨酸转氨酶192 U/L,总胆红素38.2 μmol/L,直接胆红素18.5 μmol/L;凝血功能异常,凝血酶原时间30.9 s,活化部分41.4 s,纤维蛋白原1.76 g/L.随后出现血小板计数明显下降,血小板计数43x109/L.给予输注血浆200 ml,补充凝血因子;复方甘草酸苷、还原型谷胱甘肽、舒肝宁等保肝及对症支持治疗,10 d后,患者好转出院,后门诊随访患者各项指标恢复正常.结论 左氧氟沙星导致的特异质反应可能会导致很高的发病率和病死率,在使用左氧氟沙星的时候,存在糖尿病、肝病或肝脏疾病风险的患者应谨慎使用,并密切监测肝功能,出现问题及时停药,避免导致致命的严重结果.

Objective To understand features of severe adverse reactions caused by levofloxacin.Methods Diagnosis and treatment of one case of levofloxacin induced serious adverse reaction were studied and the literature was reviewed.Results The patient had nausea,vomit and poor appetite after using levofloxacin for seven days.At the eighth day,he had irritability,flustered,cold and the heart rate increased to 148 times per minute; the blood glucose decreased to 3.1 mmol/L; the eosinophil count increased to 0.5x 109/L; the liver function was abnormal; the alanine aminotransferase increased to 3 111 U/L; the aspartate aminotransferase increased to 192 U/L;the total bilirubin increased to 38.2 μmol/L and the direct bilirubin increased to 18.5 μmol/L.The coagulation function was abnormal.The prothrombin time increased to 30.9 s ; the activated partial thromboplastin time increased to 41.4 s and the fibrinogen increased to 1.76 g/L; the platelet countobviously decreased to 43 x 109/L.All the indexes had returned to normal.Conclusions The idiosyncratic reaction may result in significant morbidity and mortality.Patients who have diabetes,liver diseases or risk ofliver diseases should use levofloxacin with caution and liver function should be monitored closely.