药物不良反应杂志
藥物不良反應雜誌
약물불량반응잡지
ADVERSE DRUG REACTIONS JOURNAL
2015年
2期
146-147
,共2页
丙硫氧嘧啶%抗中性粒细胞胞浆抗体相关性血管炎%肾小球肾炎
丙硫氧嘧啶%抗中性粒細胞胞漿抗體相關性血管炎%腎小毬腎炎
병류양밀정%항중성립세포포장항체상관성혈관염%신소구신염
Propylthiouracil%Anti-neutrophil cytoplasmic antibody-associated vasculitis%Glomerulonephritis
1例23岁女性患者因Graves病服用丙硫氧嘧啶( PTU)(早50 mg、晚25 mg与早50 mg交替)与左甲状腺素钠(12.5 mg,1次/d)。3年后,患者出现尿潜血,未予重视。5个月后,出现酱油色尿、左下腹隐痛。实验室检查:尿蛋白(++),红细胞(++++),白细胞(+);血清胞质型和核周型抗中性粒细胞胞质抗体(ANCA)均(+),蛋白酶3(PR3)27.9 RU/ml,髓过氧化物酶(MPO)>200 RU/ml。考虑为PTU诱发ANCA相关性血管炎( AAV)所致肾小球肾炎,尿路感染。停用抗甲状腺药物。因肺部CT示肺部少许炎症、肾穿刺活检进一步支持血管炎诊断,予甲泼尼龙冲击联合吗替麦考酚酯治疗。7个月后复查,尿常规未见异常;核周型ANCA(+),胞质型ANCA(-),MPO>200 RU/ml,PR32.0 RU/ml。23个月后复查,核周型ANCA(+),MPO 143 RU/ml。
1例23歲女性患者因Graves病服用丙硫氧嘧啶( PTU)(早50 mg、晚25 mg與早50 mg交替)與左甲狀腺素鈉(12.5 mg,1次/d)。3年後,患者齣現尿潛血,未予重視。5箇月後,齣現醬油色尿、左下腹隱痛。實驗室檢查:尿蛋白(++),紅細胞(++++),白細胞(+);血清胞質型和覈週型抗中性粒細胞胞質抗體(ANCA)均(+),蛋白酶3(PR3)27.9 RU/ml,髓過氧化物酶(MPO)>200 RU/ml。攷慮為PTU誘髮ANCA相關性血管炎( AAV)所緻腎小毬腎炎,尿路感染。停用抗甲狀腺藥物。因肺部CT示肺部少許炎癥、腎穿刺活檢進一步支持血管炎診斷,予甲潑尼龍遲擊聯閤嗎替麥攷酚酯治療。7箇月後複查,尿常規未見異常;覈週型ANCA(+),胞質型ANCA(-),MPO>200 RU/ml,PR32.0 RU/ml。23箇月後複查,覈週型ANCA(+),MPO 143 RU/ml。
1례23세녀성환자인Graves병복용병류양밀정( PTU)(조50 mg、만25 mg여조50 mg교체)여좌갑상선소납(12.5 mg,1차/d)。3년후,환자출현뇨잠혈,미여중시。5개월후,출현장유색뇨、좌하복은통。실험실검사:뇨단백(++),홍세포(++++),백세포(+);혈청포질형화핵주형항중성립세포포질항체(ANCA)균(+),단백매3(PR3)27.9 RU/ml,수과양화물매(MPO)>200 RU/ml。고필위PTU유발ANCA상관성혈관염( AAV)소치신소구신염,뇨로감염。정용항갑상선약물。인폐부CT시폐부소허염증、신천자활검진일보지지혈관염진단,여갑발니룡충격연합마체맥고분지치료。7개월후복사,뇨상규미견이상;핵주형ANCA(+),포질형ANCA(-),MPO>200 RU/ml,PR32.0 RU/ml。23개월후복사,핵주형ANCA(+),MPO 143 RU/ml。
A 23-year-old woman took propylthiouracil( 50 mg in the morning and 25 mg at night alternates with 50 mg in the morning)and levothyroxine sodium(12. 5 mg once daily)for Grave's disease. Three years later,the patient presented with urine occult blood,however,her symptoms did not attract attention. Five months later,the patient developed soy-colored urine and vague pain in the left lower quadrant of the abdomen. Laboratory examination showed the following results:urine protein( ++),red blood cell( ++++),white blood cell( +),perinuclear anti-neutrophil cytoplasmic antibodies( ANCA) ( +),cytoplasmic ANCA( +),proteinase 3(PR3)27. 9 RU/ml,myeloperoxidase(MPO)>200 RU/ml. She was considered as PTU-induced ANCA associated vasculitis with glomerulonephritis and urinary tract infection. PTU and levothyroxine sodium were stopped. Her chest CT scan exhibited interspersed inflamma-tion,and kidney biopsy result further verified vasculitis. She received methylprednisolone pulse therapy and mycophenolate mofetil. After 7 months,her urine routine test showed normal results,perinuclear ANCA ( +),cytoplasmic ANCA( -),MPO >200 RU/ml,and PR3 was 2. 0 RU/ml. her laboratory results showed perinuclear ANCA( +),MPO 143 RU/ml 23 months later.