老年双硫仑样反应患者的临床特征分析

Clinical characteristics of elderly patients with disulfiram-like reaction: a retrospective analysis of 19 cases

目的分析老年双硫仑反应患者的临床特征,以提高对该疾病的认识。方法回顾性分析2012年1月至2017年3月北京医院急诊科确诊的19例老年双硫样仑反应患者的病例资料。结果19例患者全部为男性,均患有1种或多种慢性基础疾病,平均发病年龄(75.6±5.1)岁;其中16例患者使用抗生素治疗,种类包括头孢曲松、头孢哌酮钠舒巴坦、头孢丙烯、头孢呋辛及莫西沙星等;另有患者发病前规律服用华法林、格列美脲、二甲双胍;主要临床症状累及心血管系统,如心悸、胸闷、胸痛、低血压等,同时可能伴有头晕、颜面潮红、意识障碍、消化道出血、肾功能障碍等表现;13例患者出现心电图活动性缺血样改变,3例患者血肌钙蛋白升高,1例患者可能遗留脏器功能受损。结论老年双硫仑样反应患者主要为男性,致病因素多样,病情凶险,心血管系统症状明显,可出现心律失常、心肌损伤、心功能不全、休克等严重心血管并发症。

Objective To analyze the clinical characteristics of elderly patients with disulfiram-like reaction, in order to raise awareness of this disease. Methods Clinical data of 19 elderly patients diagnosed as disulfiram-like reaction in the emergency department of Beijing Hospital from January 2012 to March 2017 were retrospectively analyzed.Disulfiram-like reaction was diagnosed by comprehensive data of the drugs-induced disulfiram-like reaction, related clinical manifestations, auxiliary examination, treatment response, and by differential diagnosis. Results All of 19 patients were male, with one or more chronic disease, mean ± SD age were 75.6±5.1 years.Of 19 patients, 16 patients were taking antibiotics, including ceftriaxone, cefoperazone sodium sulbactam, cefpropene, cefuroxime and moxifloxacin, and other patients received warfarin sodium, glimepiride and metformin before the onset of disulfiram-like reaction.Clinical manifestations of disulfiram-like reaction mainly involved the cardiovascular system such as palpitation, chest distress, angina, hypotension, etc., and might be accompanied by dizziness, facial flushing, awareness disorder, gastrointestinal hemorrhage, renal dysfunction, etc.The myocardial ischemia in ECG was observed in 13 patients, the elevated serum troponin in 3 patients, and a continuing organ dysfunction in 1 patient. Conclusions The elderly patients with disulfiram-like reaction are mainly male, with various pathogenic factors and dangerous prognosis.The symptoms of cardiovascular system are obvious, including arrhythmia, myocardial injury, heart failure, shock and other serious cardiovascular complications.