抗结核药物导致伪膜性肠炎一例并文献复习

Pseudomembranous colitis caused by antitubercular agents:a case report and review of literature

目的探讨抗结核药物引起伪膜性肠炎的机制、临床特征,为临床诊疗提供参考。方法报道并分析菏泽市立医院收治的1例伪膜性肠炎患者的临床资料,并收集1990年1月至2020年5月国内外报道的抗结核药物导致伪膜性肠炎的文献,分析导致伪膜性肠炎的药物及疾病临床特点、预后情况并进行总结。结果联同本例共复习抗结核药物导致伪膜性肠炎病例28例,男女比例为1.0∶1.5,中位年龄65.5岁,其中60岁及以上老年患者22例,占78.6%,28例患者症状出现时间最早至抗结核治疗后6 d、最长为126 d,中位时间为32 d。所有患者确诊伪膜性肠炎后立即停用所有抗结核药物,给予甲硝唑或万古霉素、活菌剂治疗后预后良好,继续抗结核治疗有7例复发,复发的病例中4例仅停用或以其他药物替代利福平后未再复发。结论老年患者长期使用利福平抗结核治疗伪膜性肠炎发病率增高,且易复发,应避免长时间使用利福平或以其他抗结核药物药物替代。

Objective To investigate the mechanism and clinical features of pseudomembranous colitis(PMC)caused by antitubercular agents for providing a reference for its clinial treatment.Methods One PMC case was admitted to our hospital in January 2019,and the remaining 27 cases were reported at home and abroad from January 1990 to May 2020 after the application of anti-tuberculosis drugs,all of which were obtained by literature retrieval.The domestic and foreign literature on PMC caused by antitubercular agents were reviewed.The agents causing PMC,clinical characteristics and prognosis were analyzed and summarized.Results In this paper,28 PMC cases caused by anti-tuberculosis drugs were reviewed.The ratio of men to women was 1.0∶1.5,with a median age of 65.5 years.The 22 cases were aged 60 years and over,accounting for 78.6 percent.The onset time of PMC symptoms in 28 patients was from 6 d to 126 d after anti-tuberculosis treatment,with a median time of 32 d.All patients immediately after diagnosis of PMC stopped all anti-tuberculosis drugs,and received metronidazole or vancomycin,with a good prognosis.Seven cases relapsed after continuing anti-tuberculosis treatment.Of them,4 cases had no recurrence only after stopping or replacing rifampicin with other drugs.Conclusions The incidence of PMC is increased in elderly patients with long-term use of rifampicin anti-tuberculosis treatment,and it is easy to relapse.The prolonged use of rifampicin should be avoided or replaced with other anti-tubercular agents.