关键词:结核;利福平;凝血酶原时间;凝血酶原活动度;纤维蛋白原
【摘要 】 目的 探讨利福平影响凝血因子的临床特点。方法 选择肝功能正常的颈淋巴结结核病患者73例,采用2HRZS/10HRE方案,在服药期间监测不同阶段患者血浆凝血酶原时间(PT)、活动度(PA)、纤维蛋白原(FIB)含量、肝促凝血活酶试验(HPT)、部分凝血因子活性以及丙氨酸转氨酶(ALT)。结果 48例(66%)患者在服药后5~30天出现凝血酶原时间延长,部分凝血因子活性降低。凝血因子影响程度与利福平剂量和使用期有关。在第10个月时本组患者ALT为(18±12)U/L,但PT为(19.2±3.9) s,FIB为(1.8±0.5) g/L。结论 利福平对维生素K依赖因子和非维生素K依赖因子均有影响,肝损害时不但凝血因子合成减少且凝血因子活性减低。在对肝实质损害的评价中,凝血因子的变化比转氨酶变化更为灵敏,更全面。再次使用利福平和治疗后期时ALT在正常范围,而凝血因子持续下降,应酌情考虑对策。
Changes in bloodcoagulation affected by rifampicin administration
ZHANG Haizhong, BU Rongfa, FANG Xiangqun
Department of Stomatology, PLA General Hospital, Beijing 100853
【Abstract 】 Objective Tostudy the characteristics of influence on coagulation by rifampicin (RFP)administration.Methods Seventy-three patients, ages between 10 and 65 years(mean age 30.3 years), withtuberculosis of neck lymphnode were treated with 2HRZS/10HRE. The prothrombin time,activity, fibrinogen, Ⅱ∶C, Ⅴ∶C, Ⅶ∶C, Ⅸ∶C and alanine aminotransferaseconcentration in each case were observed during the period of RFP administration. Results Theprolongation of the PT and the reduction of the PA, FIB concentration in 48 cases wereobserved after 5~30 days following RFP administration. These changes depended on drugdosage and duration, especially the severe influence on coagulation were detected when theRFP were reused after the ALT normalized in seventh to tenth months. The ALT was (18±12)U/L in the tenth month, but the PT was (19.2±3.9) s and the FIB was (1.8±0.5) g/Lrespectively. Conclusions Not only the coagulation factors Ⅱ, Ⅶ, Ⅸ,Ⅹ, but alsoⅠⅤ, Ⅵ and Ⅷ were affected by RFP. The coagulation test is more sensitive than ALTtest in the evaluation of liver injury. RFP should be stopped when FIB less than 1 g/L inspite of ALT in normal range.
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