153例利奈唑胺致耐药结核病患者神经系统不良反应分析

153 linezolid-associated neurologic adverse reactions in patients with drug-resistant tuberculosis: a retrospective analysis

目的 分析利奈唑胺(Lzd)治疗耐药结核病(DR-TB)导致的神经系统药品不良反应(ADR)影响因素和预后。方法 对郑州市第六人民医院DR-TB患者2015年1月1日至2020年12月31日应用Lzd导致的神经系统ADR情况进行统计分析。结果 563例患者有153例(27.18%)发生神经系统ADR,其中104例(67.93%)在使用Lzd 3~9个月内发生,主要表现为周围神经炎、视神经炎及视力损伤、头痛、失眠、抑郁等,52例(33.14%)合并低蛋白血症或营养不良,28例(18.30%)合并肾功能损伤。100例(65.36%)予以停药处理。对症治疗或停用Lzd后,61例(91.04%)中枢神经系统ADR和视神经炎好转,周围神经炎预后差。结论 长期应用Lzd要密切监测神经系统ADR,尽早发现并及时处理对预后有积极影响。

Objective To analyze the influencing factors and prognosis of linezolid(Lzd) associated neurologic adverse reactions in drug-resistant tuberculosis(DR-TB) patients. Methods The neurological adverse reactions caused by Lzd in DR-TB patients in the Sixth People’s Hospital of Zhengzhou between 2015 and 2020 were collected and analyzed. Results A total of 153(27.18%) neurological adverse reactions occurred in 563 patients, 104(67.93%) of which occurred within 3 to 9 months of use of LZD, mainly manifested as peripheral neuritis, optic neuritis, visual impairment, headache, insomnia and depression. Fifty-two cases(33.14%) were complicated with hypoproteinemia or malnutrition, and 28(18.30%) with renal impairment. One hundred of these cases(65.36%) were discontinued with linezolid. Sixty-one cases(91.04%) of the central neurologic adverse reactions and optic neuritis were improved after symptomatic treatment or discontinuation of linezolid, but the prognosis of peripheral neuritis was poor. Conclusion Patients with long-term use of linezolid should be monitored for neurological adverse reactions. Early detection and prompt treatment have positive effects on prognosis.