利福平致溶血性贫血临床特征与预后结局的系统评价

Systematic evaluation of clinical features and prognostic outcomes of rifampicin-induced hemolytic anemia

目的总结利福平导致溶血性贫血的流行病学、临床特征和预后结局,为指导利福平引起溶血性贫血的预防和治疗提供参考。方法检索PubMed、Web of science、Proquest、Ovid,中国知网、万方数据、维普网、SinoMed数据库,收集2023年12月31日之前报道的确诊为利福平导致溶血性贫血的临床病例。结果共有62篇文献纳入系统评价,其中45篇为中文文献,17篇为英文文献。共有69例患者因服用利福平导致溶血性贫血,年龄最小的为7个月,最大的为80岁。其中男性35例(50.72%),女性34例(49.28%)。国内报道49例,国外报道20例。42例(60.87%)在首次服用利福平后出现溶血性贫血,24例(34.78%)在间歇用药后出现溶血性贫血,3例(4.35%)溶血性贫血发生时间不详。这些患者主要表现为发热、寒战、恶心、呕吐,同时多伴有白细胞、转氨酶、胆红素、肌酐升高和血红蛋白显著降低,严重者可出现溶血性尿毒综合征。临床治疗措施主要包括立即停药、吸氧、补液、维持水和电解质酸碱平衡、利尿、碱化尿液、应用激素、抗过敏药、保肝药、输血、血液透析、血浆置换和腹膜透析等治疗方式。经治疗,52例(75.36%)患者病情好转出院,10例(14.49%)死亡,7例(10.14%)结局不详。结论利福平导致溶血性贫血事件近年来均有报道,任何年龄段患者皆可发生,间歇使用利福平更易导致溶血性贫血。溶血性贫血的早期症状主要是流感样症状和胃肠道不适,及时治疗一般预后良好,但也可能病情迅速进展,严重病例可能导致死亡。

Objective To summarize the epidemiology,clinical features and prognostic outcomes of rifampicin-induced hemolytic anaemia,and to provide data for the prevention and treatment of rifampicin-induced hemolytic anaemia.Methods A systematic evaluation was conducted by searching such databases as Pubmed,Web of Science,Proquest,Ovid,China Knowledge,Wanfang data,Wipo,and SinoMed.Clinical cases with confirmed diagnosis of rifampicin-induced haemolytic anaemia reported before December 31,2023 were collected.Results A total of 62 pieces of literature were included in the evaluation,consisting of 45 in Chinese and 17 in English.Among the 69 patients with rifampicin-induced haemolytic anaemia,the age ranged from 7 months to 80 years.There were 35 male cases(50.72%)and 34 female ones(49.28%).Forty-nine cases were reported in China and the rest abroad.Haemolytic anaemia occurred in 42 cases(60.87%)after the first dose of rifampicin,in 24 cases(34.78%)after intermittent use of the drug,but the time of onset was unknown in three cases(4.35%).Common clinical manifestations included fever,chills,nausea,and vomiting,often accompanied by elevated white blood cells,liver aminotransferases,bilirubin,creatinine,and a significant decrease in haemoglobin.Treatments mainly involved immediate drug withdrawal,oxygenation,fluid replacement,maintenance of water and electrolyte acid-base balance,diuresis,alkalinisation of urine,application of hormones,anti-allergic drugs,hepatoprotective drugs,blood transfusion,haemodialysis,plasma exchange,and peritoneal dialysis.After treatment,52 patients(75.36%)showed improvement and were discharged,10 patients(14.49%)died,and the outcome was unknown in 7 patients(10.14%).Conclusion Rifampicin-induced haemolytic anaemia has been reported in recent years and can strike patients of any age,and intermittent use of rifampicin is more likely to result in haemolytic anaemia.The early symptoms of haemolytic anaemia are mostly influenza symptoms and gastrointestinal discomfort.Prompt treatment usually has a good prognosis,but the disease may progress rapidly and may to death in severe cases.