1例抗中性粒细胞胞浆抗体相关性血管炎合并肺结核患者的药学监护

Pharmaceutical care on a patient with antineutrophil cytoplasmic antibody associated vasculitis complicated with pulmonary tuberculosis

1例22岁女性患者,入院诊断为“抗中性粒细胞胞浆抗体(ANCA)相关性血管炎、巩膜炎”,入院后静脉予糖皮质激素治疗,后序贯为口服甲泼尼龙片,静脉予环磷酰胺(0.4g,qw),诊断性抗结核治疗予口服利福平胶囊(0.45g,qd),异烟肼片(0.3g,qd),左氧氟沙星片(0.5g,qd),吡嗪酰胺片(0.5g,tid)。住院期间患者眼红、眼痛、头痛症状时轻时重。临床药师发现利福平能增加糖皮质激素的清除,且可引起头痛,因此建议调整糖皮质激素服用时间及剂量或停用利福平。利福平停用4d后,患者各种不适均明显好转予以出院。

A 22-year-old female patient who diagnosed as antineutrophil cytoplasmic antibody(ANCA)associated vasculitis and scleritis was given glucocorticoid intravenously followed by oral methylprednisolone tablets,cyclophosphamide intravenously(0.4 g,qw),and empirical anti-tuberculosis therapy including rifampine capsules(0.45 g,qd),isoniazid tablets(0.3 g,qd),levofloxacin tablets(0.5 g,qd),and pyrazinamide tablets(0.5 g,tid)after admission.The symptoms of the patient including red eyes,ophthalmalgia and headache sometimes relieved and sometimes aggravated.Clinical pharmacists found that rifampicin increased the clearance of glucocorticoids,which could cause headache.So pharmacists advised to adjust the taking time and dosage of glucocorticoids or stop rifampicin.After 4 days of withdrawal of rifampicin,all symptoms significantly improved and the patient was discharged.