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1例25岁女性肺结核并肠结核患者应用HRZE方案化疗,即口服异烟肼(H)0.3 g,1次/d;利福平(R)0.45 g,1次/d;吡嗪酰胺(Z)3 g,1次/3 d;乙胺丁醇(E)0.75 g,1次/d。服药3 d后出现肝功能损害,6 d后出现急性肝衰竭伴肝性脑病。实验室检查:丙氨酸转氨酶(ALT)519 U/L,天冬氨酸转氨酶(AST)1854 U/L,白蛋白29.6 g/L,总胆红素(TBil)89.9μmol/L,直接胆红素(DBil)59.2μmol/L,凝血酶原时间113 s,国际标准化比值9.18,D-二聚体0.8 mg/L。立即停用所有抗结核药物,给予多烯磷脂酰胆碱、还原型谷胱甘肽、丁二磺酸腺苷蛋氨酸、前列地尔、香丹注射液。第9天患者出现昏迷,加用果糖二磷酸钠、甘露醇;行血浆置换术;输注新鲜冰冻血浆、冷沉淀。第11天患者苏醒,继续支持治疗。1个月后复查:ALT 25 U/L,AST 64 U/L,白蛋白39.4 g/L,TBil 65.8μmol/L,DBil 40.2μmol/L。
A 25-year-old woman with tuberculosis and enteric tuberculosis was treated with HRZE regimen: 0.3 g of isoniazid (H) orally, once per day, 0.45 g of rifampin (R) once daily, ) 3 g, 1 time / 3 d; ethambutol (E) 0.75 g, 1 time / d. After 3 days of medication, liver damage occurred, and acute liver failure and hepatic encephalopathy occurred after 6 days. Laboratory tests included 519 U / L of ALT, 1854 U / L of AST, 29.6 g / L of albumin and 89.9 μmol / L of total bilirubin (TBil) 59.2 μmol / L DBil, 113 s prothrombin time, the international standardization ratio 9.18, and the D-dimer 0.8 mg / L. Immediately disable all anti-tuberculosis drugs, give polyene phosphatidylcholine, reduced glutathione, adenosine methionine butadifenamate, alprostadil, Xiangdan injection. On the 9th day, the patient appeared unconscious, added with sodium fructose diphosphate and mannitol. Plasma exchange was performed. Infusion of fresh frozen plasma and cryoprecipitation. On the 11th day, the patient recovered and continued to support the treatment. One month after the review: ALT 25 U / L, AST 64 U / L, albumin 39.4 g / L, TBil 65.8 μmol / L, DBil 40.2 μmol / L.