全球精选文摘 - 最新进展：不良事件数据和美国胸腔学会/疾病预防控制中心有关禁止使用利福平和吡嗪酰胺治疗潜伏结核感染的修订建议--美国，2003年

Update: Adverse Event Data and Revised American Thoracic Society/CDC Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of Latent Tuberculosis Infection—United States, 2003

Centers for Disease Control and Prevention, American Thoracic Society 2009/6/24 11:46:54

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MMWR Morb Mortal Wkly Rep, 2003,

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Abstract
Background:
The US Centers for Disease Control and Prevention (CDC) has cautioned clinicians regarding the use of a daily and twice-weekly 2-month regimen of rifampin with pyrazinamide (RZ) for the treatment of latent tuberculosis infection (LTBI). These cautions were issued as a result of reports of severe liver injury in some of these patients. The incidence of RZ-associated severe liver injury was estimated, and more precise data were provided to guide the treatment of LTBI. A summary of findings in a CDC analysis of cohorts of patients in the United States who received treatment of LTBI during a 30-month period was also included.

Methods:
A case of severe liver injury was defined as one that resulted in the hospitalization or death of a patient being treated for LTBI with RZ. A 2-phase retrospective survey was conducted by the CDC among persons receiving RZ for the treatment of LTBI and their health-care providers from January 2000 to June 2002. The reporting continued through June 2003.

Results:
From October 2000 through June 2003, the CDC received reports of 48 patients with confirmed cases of severe liver injury in a patient being treated for LTBI with RZ. A majority (69%) of these cases occurred in the second month of treatment. Of the 48 patients identified, 11 (23%) died, including 2 persons known to be infected with HIV. On the basis of these findings, the CDC and the American Thoracic Society (ATS) have revised their recommendations for the treatment of LTBI in adults. These recommendations have also been endorsed by the Infectious Diseases Society of America (IDSA).

Conclusions:
On the basis of these findings and the investigation of potential cofactors in the 48 cases of serious liver injury in this report, this regimen of rifampin and pyrazinamide should never be offered to patients who are concurrently taking other medications associated with liver injury, and patients who drink excessive amounts of alcohol, even if its use is discontinued during treatment. Patients should also not be given this regimen if they have underlying liver disease or have a history of isoniazid-associated liver injury.

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疾病资源中心

高血压	慢性阻塞性肺病
脂肪性肝病	糖尿病
卒中	肺癌
冠心病	子宫内膜异位症
结直肠癌	乳腺癌
心力衰竭	心律失常

病例分析 [栏目介绍]

甲状腺功能亢进合并黄疸

王燕燕王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。

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