一线抗结核药物对眼部损害的研究进展

Research progress of eye damage caused by first-line anti-tuberculosis drugs

抗结核药物对眼部的损害随着结核患病率增高而逐年上升。乙胺丁醇的不良反应主要是乙胺丁醇中毒性视神经病变,偶见视网膜毒性。其机制可能是线粒体与金属的螯合作用,使线粒体功能受损,三磷酸腺苷合成受阻,进而影响神经轴突从胞体向远侧运输线粒体,能量被耗竭并发轴突水肿、神经细胞的凋亡。每日剂量、肾脏功能情况对乙胺丁醇中毒性视神经病变的发生影响大,停药后少于1/3的患者视力有改善。老年人和肾功能障碍者,乙胺丁醇的使用剂量应低于常规剂量。异烟肼不良反应主要是中毒性视神经病变,偶尔出现外展神经麻痹和儿童球后视神经炎。其机制可能是异烟肼与维生素B6发生竞争性抑制,导致体内维生素B6的丢失或阻碍吡哆醛合成,从而消耗神经递质。异烟肼的总剂量对中毒性视神经病变发生影响大;常规剂量可出现外展神经麻痹。利福平和吡嗪酰胺的不良反应较少见。

The eye injury caused by anti-tuberculosis drugs increases year by year as the prevalence of tuberculosis.The main adverse reactions of ethambutol are ethambutol toxic optic neuropathy and occasional retinal toxicity.The mechanism might be chelation of mitochondria with metals,the impaired function of mitochondria,and the inhibited synthesis of ATP,so as to affect the transport of mitochondria from the cell body to the distal side of nerve axons while the energy is exhausted.It could be accompanied by axon edema,and the apoptosis of nerve cells.Daily dose and renal dysfunction have a great impact on the occurrence of ethambutol toxic optic neuropathy.Less than 1/3 patients had improved visual acuity after withdrawal.The usage of ethambutol should be lower than conventional dose for the elder and the renal dysfunction people.The main adverse reactions of isoniazid are toxic optic neuropathy,abducens nerve paralysis and retrobulbar optic neuritis in children.The loss of vitamin B6 by using isoniazid or the blocking of pyridoxal phosphate synthesis so as to consume the neurotransmitters caused by the competitive inhibition between isoniazid and vitamin B6 could be the pathogenesis of isoniazid toxic optic neuropathy.The accumulated dose of isoniazid could have great effect on toxic optic neuropathy,and conventional dose could cause abducens nerve paralysis.The adverse reaction of rifampicin and pyrazinamide is scarce.