摘要
目的:分析儿童结核病患者发生抗结核药物相关急性肝衰竭的临床特征、治疗措施及预后。方法:对3例发生抗结核药物相关急性肝衰竭结核病患儿的临床表现、检查结果、治疗措施及预后进行报道,并回顾分析国内外文献。以“急性肝衰竭、结核病、儿童”为检索词检索万方、维普及中国知网数据库,以“acute liver failure、tuberculosis、child/children”为检索词检索PubMed数据库,检索时间为1980年1月至2021年12月。收集包括患儿的年龄、抗结核药物治疗方案、服用抗结核药物时间、服用其他可以引起肝损伤的药物、治疗结局等信息,剔除因预防性抗结核治疗而导致肝衰竭的病例。结果:本院收治了3例患儿,男性1例,女性2例。3例患儿结核病灶累及胸腔、腹腔,2例患儿结核病灶累及中枢神经系统。3例患儿均有低蛋白血症。经治疗后2例死亡,1例存活。通过文献复习获得6例患儿信息,加上本研究报道的3例患儿,共计9例。9例患儿年龄范围为0.25~12.80岁,年龄中位数(四分位数)为10.70(5.02,12.70)岁。4例患儿使用H-R-E-Z(H:异烟肼,R:利福平,E:乙胺丁醇,Z:吡嗪酰胺)抗结核治疗方案,余5例使用H-R(2例)、H-R-Z(2例)、H-R-E-S(S:链霉素)(1例)。本研究中4例患儿存活,5例死亡。3例患者年龄<10岁,2例患者死亡,1例接受肝移植的患者存活。结论:结核病患儿发生抗结核药物相关急性肝衰竭大多在使用抗结核药物治疗1个月内,且年龄越小预后越差。
Objective:To analyze the clinical features,therapeutic measures and prognosis of anti-tuberculosis therapy-associated acute liver failure in children with tuberculosis.Methods:The clinical manifestations,examination results,therapeutic measures and prognosis of three children with anti-tuberculosis therapy-associated acute liver failure were reported.Literatures were reviewed on the published reports between January 1980 and December 2021 by searching with the key words of“acute liver failure,tuberculosis,child/children”in Wanfang,WPCS,CNKI and PubMed.Information was collected,including the patient’s age,anti-tuberculosis treatment plan,duration of taking anti-tuberculosis drug,usage of other drugs that can cause liver injury,and treatment outcome,etc.Cases of liver failure caused by tuberculosis preventive treatment were excluded.Results:Three patients were admitted to our hospital,including 1 boy and 2 girls.Tuberculosis was involved in thoracic,abdominal cavity in 3 children and involved in central nervous system in in 2 children.All the three cases had hypoproteinemia.After treatment,2 died and 1 survived.Through literature review,the data of 6 cases were obtained.The total number of subjects was 9 cases,including three cases reported above.The age of 9 cases ranged from 0.25 to 12.80 years,and the median age(quartile)was 10.70(5.02,12.70)years.Four cases were treated with H-R-E-Z(H:isoniazid,R:rifampin,E:ethambutol,Z:pyrazinamide)regimen,and the other five were treated with H-R(2 cases),H-R-Z(2 cases),and H-R-E-S(S:streptomycin;1 case).In this study,four cases survived and five died.Of the three cases aged<10 years old,two died and one who received liver transplantation survived.Conclusion:Anti-tuberculosis therapy-associated acute liver failure in children mainly occurred within 1 months after taking anti-tuberculous drugs.The younger the case,the worse the prognosis of liver failure.
作者
梁丽
邹莉萍
谢芳晖
陈晴
吴桂辉
LIANG Li;ZOU Li-ping;XIE Fang-hui;CHEN Qing;WU Gui-hui(Department of Tuberculosis,Chengdu Public Health Clinical Medical Center,Chengdu 610061,China)
出处
《中国防痨杂志》
CAS
CSCD
2022年第4期343-348,共6页
Chinese Journal of Antituberculosis
基金
四川省医学科研课题计划(S18027)。
关键词
儿童
抗结核药
药物毒性
肝功能衰竭
病例报告
Child
Antitubercular agents
Drug toxicity
Liver failure
Case reports
