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1 病例报告 例1:女,36岁。因患腹泻间断口服肠炎灵(内含利福平、次硝酸铋)6个月。入院前20天重服肠炎灵4粒,50分钟后周身皮肤出现出血点及瘀癍。当时查血小板20×10~9/L,以血小板减少性紫癜治疗后好转。本次入院因又服用肠炎灵4粒,20分钟后牙龈出血,周身皮肤出现大片瘀癍,当日24小时尿量<100ml。入院后查体:周身皮肤散在瘀癍、出血点,瘀癍相连成大片。束臂试验阳性。血小板40×10~9/L,尿蛋白(+++),RBC(++++),尿比重1.009,BUN26.27mmol/L,Cr844.5/μmol/L。血FDP35mg/L,尿FDP23mg/L。骨髓片:粒系增生活跃占有核细胞77.2％,各阶段比例大致正常。多数中幼粒以下粒细胞胞浆可见中毒颗粒。视片一张见巨核17只。其中颗粒巨5只,裸核巨12只,血小板散在少见。诊断为利福平致急性肾衰合并血小板减少性紫癜。入院后第4日行血液透析治疗。每周2次,4周透析8次。伍用强地松10mg,3次/日口服。3周进入多尿期,血小板200×10~9/L,6周BUN7.0mmol/L,Cr123.3μmol/L,尿蛋白阴性。尿比重于第9周恢复到1.020,血小板240×10~9/L,痊愈出院。
1 Case Report Example 1: Female, 36 years old. Due to diarrhea intermittent oral enteritis (containing rifampin, bismuth sub nitrates) for 6 months. 20 days before admission heavy dose enteritis 4, 50 minutes after the whole body skin bleeding and stasis. At that time check the platelets 20 × 10 ~ 9 / L to thrombocytopenic purpura after treatment improved. The admission due to take enteritis 4, bleeding gums after 20 minutes, the whole body skin stasis, 24-hour urine output <100ml. After admission, physical examination: whole body skin scattered in stasis, bleeding, stasis linked to blockbuster. Beam arm test positive. Platelets 40 × 10 ~ 9 / L, urinary protein (+++), RBC (++++), urine specific gravity 1.009, BUN26.27mmol / L, Cr844.5 / μmol / L. Blood FDP35mg / L, urine FDP23mg / L. Marrow slices: granulocytic proliferative active accounting for 77.2% of the nuclear cells, the proportion of roughly the normal stage. Most of the following granulocytes in cytoplasm poisoning particles can be seen. See a megapixel 17 film. One of the giant particles 5, bare nuclear giant 12, scattered platelet rare. Diagnosis of rifampin-induced acute renal failure with thrombocytopenic purpura. Hemodialysis was performed on the 4th day after admission. 2 times a week, 4 weeks dialysis 8 times. Wood with strong pine 10mg, 3 times / day orally. Three weeks into the polyuria, platelet 200 × 10 ~ 9 / L, 6 weeks BUN7.0mmol / L, Cr123.3μmol / L, urine protein negative. The proportion of urine returned to 1.020 in the 9th week and 240 × 10 ~ 9 / L in the platelet. All patients were cured and discharged.