摘要
头孢菌素是临床上常用的一类广谱抗生素 ,随着头孢菌素的广泛使用 ,少数患者可出现血液系统毒性反应。头孢菌素可诱发免疫性溶血性贫血 ,也可仅表现为Coombs实验阳性而无溶血的证据。在个别病例中 ,头孢菌素可通过免疫机制导致白细胞减少甚至粒细胞缺乏 ,但大量临床资料表明 :第三、四代头孢菌素用于粒细胞缺乏病人发热的治疗是安全的。凝血功能障碍和出血是头孢菌素的血液学毒性反应中最严重的 ,主要由于干扰了维生素K的代谢引起低凝血酶原血症和依赖维生素K的凝血因子活性降低 ,同时还可抑制血小板聚集 ,尤其是含有N MTZ结构的头孢菌素 ,表现尤为突出。了解头孢菌素的血液学毒性反应有利于临床医生合理用药 ,尤其对有维生素K缺乏可能的病人 ,在使用N
Cephalosporins are widely used in clinical practice owing to their remarkably broad-spectrum of antibacterial activity.However,cephalosporins may have a few side effects associated with haematological diseases.Cephalosporin may induce an immune-mediated hemolytic anemia,but some patients can also present a positive Coombs' test without the evidences of hemolysis.Cephalosporins can result in neutropenia through an immune mechanism in rare cases,neverthless many clinical trails show that the third- and the fourth-generation cephalosporin may be safety to patients with neutropenia and fever.Coagulopathies and bleeding are probably the most serious side effects caused by cephalosporins.Most cases of bleeding are caused by either vitamin K-responsive hypoprothrombinemia and decreased activities of coagulant factors depending on vitamin K,or an acquired platelet functional defect.The complications of coagulopathies and bleeding may be observed frequently in cases using cephalosporins containing N-MTZ molecular structure.Knowledge of haemotological side effects related to cephalosporins can help physicians use them reasonably.Clinicians should pay more attention to patients with absence of vitamin K while the cephalosporins containing N-MTZ molecular structure are being administrated.
出处
《临床内科杂志》
CAS
北大核心
2003年第9期455-457,共3页
Journal of Clinical Internal Medicine
