抗结核药物副反应分析

目的了解抗结核治疗过程中各种药物的副反应及处理方法。方法对1996—2006年在汕头市结核病防治所就诊的628肺结核患者进行临床分析。结果抗结核治疗过程中出现药物副反应患者201例，占肺结核患者32％，55～76岁组药物副反应明显高于15～54岁组，差别有统计学意义（P〈0．05）。其中35例经护肝、抗过敏等对症处理，各种副反应消失，继续原方案化疗，占药物副反应患者的17．4％；因药物副反应而改变最佳治疗方案者113例，占副反应患者56．2％，占就诊肺结核患者18．0％；中断治疗者53例，占副反应患者26．4％，占就诊肺结核患者8．4％。结论抗结核治疗过程中各种副反应较常见，正确认识和处理各种副反应，合理用药，可提高治愈率，有助于控制结核病的蔓延。     

抗结核药物所致皮肤副反应及其对策(附64例报告)

抗结核药物的应用，显著提高了结核病的治疗效果，但药物引起的皮肤副反应亦较常见，由于缺乏认识，可发展为严重的剥脱性皮炎。现总结我院１９８５年１月～１９９８年１２月间因抗结核药物所致皮肤副反应６４例，进行分析并提出对策。１资料和方法１．１选例标准：结核病诊断明确。皮疹出现正值抗结核治疗时，并排除其他药物引起皮疹的可能。经重复试用明确所致药物。１．２一般情况：６４例中男５３例，女１１例，年龄１６～６６岁，平均４９．１岁。１７例有既往药物过敏史，占２６．６％，对两种以上抗结核药物过敏的１１例中，有过敏史…     

66例因抗结核药物副反应停药病例的分析

本文总结我所近十年来临床用药过程中,因副反应停药处理的66例进行分析。一般情况 66例中男性43例,女性23例。年龄15～19岁24例,20～39例25例,50～59岁9例,60岁以上8例。各种抗结核药物引起副作用的例数:INH18例,PAS16例,SM17例,RFP18例,RFD1例,EMB9例,PZA12例,TH13214例,SV1例。其中因一种药引起副反应者38例,二种药25例,三种药相继引起3例。     

抗结核药物副作用的对策

随着一些新的抗结核药物的临床应用，对结核病的短程化疗，以及初治、复治、难治性肺结核的化疗都取得了较好的疗效，但各种抗结核药物的副作用也逐渐增多，以下介绍本科在诊治肺结核病期间遇见的各种药物副作用患者242例，占同期收治患者的11％。经过调整化疗方案，辅助治疗及停药等对症处理，大部分患者都顺利完成治疗方案，达到予期目的。     

抗结核药物所致皮疹临床特点及停药指征的探讨

目的 探讨抗结核药物所致皮疹的临床特点及停药指征.方法 对1998-2005年收治的3 082例住院结核病人中,因抗结核药物所致皮疹296例病人进行分析.结果 变态反应总发生率为10.3%,皮疹发生率为9.6%（296例）,其中单纯皮疹88例,占2.9%,皮疹伴其他系统表现一种或一种以上者208例,占6.7%;无皮疹者22例,占0.7%.皮疹病例总停药率为61.5%.结论 抗结核药物所致过敏反应多为全身性,发生过敏反应后,绝大多数单纯皮疹病人经过抗过敏处理后仍可维持原方案继续治疗,而皮疹伴有明显肝功能异常、心律失常、关节痛和过敏性休克者均需立即停用抗结核药物,并且避免再次使用.     

抗结核药物所致皮疹临床特点及停药指征的探讨

目的探讨抗结核药物所致皮疹的临床特点及停药指征。方法对1998—2005年收治的3 082例住院结核病人中,因抗结核药物所致皮疹296例病人进行分析。结果变态反应总发生率为10.3%,皮疹发生率为9.6%(296例),其中单纯皮疹88例,占2.9%,皮疹伴其他系统表现一种或一种以上者208例,占6.7%;无皮疹者22例,占0.7%。皮疹病例总停药率为61.5%。结论抗结核药物所致过敏反应多为全身性,发生过敏反应后,绝大多数单纯皮疹病人经过抗过敏处理后仍可维持原方案继续治疗,而皮疹伴有明显肝功能异常、心律失常、关节痛和过敏性休克者均需立即停用抗结核药物,并且避免再次使用。     

抗结核药物致皮疹临床特点及停药指征的探讨（附228例临床分析）

目的探讨抗结核药物所致皮疹的临床特点及停药指征。方法对我院1998～2003年收治的2335例住院结核病人中，对抗结核药物所致皮疹228例病人进行分析，主要包括皮疹发生率、伴随症状和停药情况。结果皮疹发生率为9．8％，228例病人中单纯皮疹55例，占24．1％，皮疹伴其它系统表现一种或一种以上者173例，占75．9％。总停药率为57％。结论抗结核药物所致过敏多为全身性，发生过敏反应后，绝大多数单纯皮疹病人，经过抗过敏处理后仍可维持原方案继续治疗，而皮疹伴有明显肝功能异常、心律异常、关节痛和过敏性休克者均需立即停用抗结核药物，并且避免再次使用。     

口服阿莫西林致严重过敏反应1例并文献复习

严重过敏反应近年来引起国内外医生广泛关注,国外对此研究较为深入。Liew等[1]的研究提示近年来严重过敏反应发生率增高,而药物引发的严重过敏反应病死率增高,需引起我们重视。青霉素类药物过敏在药物过敏中最为常见,尤其静脉应用时过敏可能引发过敏性休克等严重情况,但口服青霉素类药物引发严重过敏反应并不多见,现报告我院一例口服阿莫西林引发严重过敏反应病例,并结合文献加以分析。     

结核药致皮肤过敏28例分析

有关结核药物引起皮肤过敏已有报道,为进一步了解一线抗结核药引起皮肤过敏的情况并研究其对策,特对我院2000年～2001年28例结核病人在抗痨过程中出现皮肤过敏反应情况及其处理进行讨论.结果:药疹是抗结核药的常见副反应之一,常用一线结核药发生过敏反应的机率大小依次为INH、RFP、SM、EB和PZA.脱敏疗法是保证抗痨顺利进行及对付一线抗结核药物皮肤过敏反应的主要方法.     

抗结核药物引起的副作用综合报告

本文综合报告由于抗结核药物的副作用致并发病72例,其中流感样综合征6例、急性肾功能衰竭2例、溶血性贫血及心律失常各1例、明显消化道障碍2例(均由利福平所致);过敏性休克4例(利福平引起2例,利福霉素及链霉素各1例);血小板减     

Clinical trial on furapyrimidone in filariasis

A clinical trial was carried out with furapyrimidone in treating 51 patients with B. malayi, 159 with W. bancrofti and eight with D. perstans using different dosage schedules. Two hundred and fifty-seven cases of Malayan and bancroftian filariasis were treated with hetrazan for comparison. The results based on the microfilaricidal effects suggest that furapyrimidone possesses similar therapeutic effects of hetrazan on Malayan filariasis at eight-month follow-up, and higher incidences of microfilarial disappearance of W. bancrofti infection (81.3%) at six-month follow-up. The drug was also effective against D. perstans. The side effects consisted of fever and irritation of the digestive tract. Fever may be related to allergic reaction of foreign protein from the dead or dying parasites. The side reactions are similar to those of hetrazan and usually not serious. Comparing the efficacies and side effects of furapyrimidone with different dosage schedules the authors recommend regimens of 15 to 20 mg/kg/day for six days in treating Malayan filariasis and 20 mg/kg/day for seven days in treating bancroftian filariasis.     

Short-course rifamycin and pyrazinamide treatment for latent tuberculosis infection in patients with HIV infection: the 2-year experience of a comprehensive community-based program in Broward County,Florida

OBJECTIVES: To determine the completion rate and tolerability of short-course rifamycin and pyrazinamide treatment of latent tuberculosis infection (LTBI) in HIV-infected patients through a comprehensive community-based program. DESIGN: Prospective cohort, with comparison to a historical control group. PATIENTS: Of 3,118 patients with HIV infection screened for LTBI between February 1999 and March 2001, 135 patients were placed on rifamycin/pyrazinamide for 2 months under directly observed therapy and were compared to a historical group comprised of 93 HIV-infected patients who were placed on self-administered treatment of isoniazid for 12 months between 1996 and 1998. RESULTS: Of 135 patients receiving rifamycin/pyrazinamide, 124 patients (92%) completed treatment; 5 patients had to discontinue treatment due to side effects (allergic skin reactions [n = 4], hepatitis [n = 1]). The completion rate of the historical group who received isoniazid therapy was 61% (57 of 93 patients; p < 0.001); none of those who received isoniazid experienced significant side effects. CONCLUSION: In our experience, a comprehensive, community-based program of rifamycin/pyrazinamide for LTBI achieved significantly higher adherence than that of traditional isoniazid therapy, and thus may provide improved tuberculosis prevention in a community with high prevalence of HIV-infected patients.     

Adverse effects in children receiving short-term chemotherapy for intrathoracic tuberculosis

The incidence and pattern of adverse effects were analyzed in children receiving short-term chemotherapy for intrathoracic tuberculosis in relation to the course of a tuberculous process (complicated and uncomplicated). During chemotherapy, side effects of antituberculous agents were noted in 82 children of 255 examinees. The incidence of side effects was affected by concurrent diseases detected in 52.4% of children showing a poor tolerance, receiving antituberculosis therapy for up to 6 months. Adverse effects were found in 18.2% of children, and in 55.3% with over 12-month chemotherapy. Short-term chemotherapy in children with the uncomplicated course of tuberculosis significantly reduced the incidence of adverse responses as compared to long-term chemotherapy (20 versus 36%) by reducing allergic reactions by 3 times (6.7 versus 19.7%). In children with complicated tuberculosis, the use of 4 drugs in the intensive phase of chemotherapy failed to increase the incidence of side effects (35.5 versus 40.8%). In most children, adverse reactions are reversible and a complete intolerance of antituberculous agents (streptomycin and rifampicin) was observed only in 4% of cases.     

抗甲状腺药物不良反应的再认识

抗甲状腺药物(ATD)是治疗甲状腺功能亢进症主要手段,其不良反应备受学者们关注.ATD常用药物为丙基硫氧嘧啶(PTU)和甲巯咪唑(MMI).总的来说,ATD治疗是安全且有效的,但其临床不良反应亦较常见,如对肝脏、血液系统的毒性作用、抗中性粒细胞胞浆抗体相关性肺小血管炎、低血糖、变态反应、肌肉损伤等,一般程度较轻,如能及时停用ATD则能够自行恢复,但亦可出现少见、严重的副作用,可能存在潜在致命的危险,故需引起临床医生的重视.MMI与PTU比较,其不良反应显著低于PTU,且前者大多具有剂量依赖性,后者与药物的剂量无显著相关.此外,PTU的肝毒性强于MMI,甚至可能发生致命性肝损伤和肝衰竭,在儿童甲亢治疗中推荐首选MMI.

Abstract：

Antithyroid drugs(ATD)is the main treatment for hyperthyroidism and its adverse reactions have been much concerned by physicians. Methimazole(MMI)and propylthiouracil(PTU)are the two common antitithyroid drugs used currently. Generally, the ATD are safe and effective, though their clinical adverse reactions are also relatively common. The toxic effects include liver damage and leukocytopenia, antineutrophil cytoplasmic antibody-associated pulmonary small-vessel vasculitis, hypoglycemia, allergic reactions, muscle impairment,and so on. They are usually reversible and disappear spontaneously when the drug is discontinued. However,the serious rare side effects can also occur and there may have potentially deadly threatening effects which need to be cautious for the clinicians. MMI is usually preferred over PTU because it has significantly fewer side effects. And unlike the dose-dependent side effects of MMI, there has no significant correlation between adverse reaction and drug dosage in using PTU. Moreover, PTU has more severe hepatotoxity than MMI, even fatal liver impairment and liver failure. The risk of liver damage from PTU is an important concern, particularly in children. For this reason, MMI is the first choice for treating children with hyperthyroidism.     

老年肺结核合并糖尿病对抗结核药物耐受性的探讨

目的 探讨老年患者对抗结核药物的耐受性和用药原则。方法 对96例老年肺结核中糖尿病组47例与对照组49例使用抗结核药物后出现的副反应进行对比分析。结果 两组男性抗结核药物副反应发生率均高于女性,血糖水平的高低与总的抗结核药物副反应的发生无明显相关性,但糖尿病组第八对颅神经损伤率明显高于对照组。两组抗结核药物副反应均以胃肠反应及肝损为主,其次为第八对颅神经损伤。结论 老年患者抗结核药物剂量应适当减少,慎用或不用氨基糖苷类药物,尤其是合并糖尿病者使用氨基糖苷类药物更易出现第八对颅神经损伤,使用时应严密观察。     

抗结核药物引起的副作用604例临床分析

目的 了解抗结核药物副作用发生情况。方法 对1990～1998年住院肺结核患者1848例进行临床分析。结果 抗结核药物副作用604例 (32.7%),以肝损害、位听神经损害、血液学异常及胃肠反应为主 (82.1%),因副作用致终止治疗率14.6%。77%的副作用出现于给药的2个月内,血液学异常的50%以上在用药的3个月后出现。结论 抗结核药物引起的副作用常见,分布较广,应引起临床工作者高度重视。     

Adverse reactions of antituberculous agents, especially about its onset and duration

We examined the adverse reactions of the antituberculous agents in 225 hospitalized patients (150: male, 75: female, average age: 45.4 years old) and the results were summarized as follows: 1) The side effects were seen in 53 patients (23.6%), and the abnormal laboratory findings were observed in 94 patients (41.8%). 2) The incidence of adverse reactions in patients treated with three drugs (INH, RFP, EB) and four drugs (plus SM) were 45.9% and 82.4%, respectively. 3) Adverse reaction appeared within one month after starting treatment in 67.9% of eligible patients, and it disappeared within one month from its onset in 76.8% of patients. There results suggested the importance of careful clinical observation especially soon after starting antituberculous therapy.     

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特异性免疫治疗主要包括皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT),经全世界各国医生临床研究表明是安全的。它的不良反应主要是过敏反应,常见为局部表现,但严重全身性不良反应可以威胁患者生命甚至死亡。不良反应常见于剂量递增阶段,SCIT注射后短时间内出现手心和脚底烧灼感、痒感和热感,全身荨麻疹是严重全身不良反应的前驱症状,应立即肌注或静注抗阻胺药,出现低血压症状立即肌注肾上腺素;在治疗前与患者做好沟通,遵守其说明书的要求,注意其危险因素,同时在治疗早期联合药物治疗控制患者过敏性疾病的症状,可以有效减少免疫治疗的不良反应。     

Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.     

Treatment. Corticosteroids and anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs and corticosteroids are important elements in the therapeutic armamentarium for patients with systemic lupus. The choice of NSAID needs to be individualized, but with optimal usage NSAIDs can often be used to manage symptoms previously treated with corticosteroids. For serious disease manifestations, corticosteroids are the cornerstone of therapy. Maximization of clinical response and avoidance of side effects continue to be important management goals. Different dosage regimens, such as intravenous methylprednisolone pulse therapy, and adjunctive agents, such as cyclophosphamide, are of continued interest in severe and potentially life-threatening disease. In addition, new nonsteroidal anti-inflammatory strategies including omega-3 series eicosanoids and new steroidal strategies including deflazacort and anti-glucocorticoids hold promise for continued improvement in the treatment on systemic lupus.