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异烟肼中毒

Author
Rama B Rao, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
王军, 主任医师

引言

异烟肼(isoniazid, INH)是一种治疗结核分枝杆菌(Mycobacterium tuberculosis, TB)感染的抗生素。世界上很大一部分人口都会感染TB。虽然大多数患者的疾病为非活动性，但多达10%的此类患者可能在有生之年里出现感染性[1-3]。许多有可能发生活动性、感染性TB或已出现活动性疾病的患者都会接受INH治疗。

急性INH毒性通常表现为神志改变或癫痫发作。蓄意自杀、为弥补漏服而额外摄入药物或儿童意外摄入都有可能引起INH中毒[4-6]。慢性INH中毒常表现为周围神经病或肝毒性，不过其他慢性疾病也有报道。

本专题将讨论急性INH中毒的表现和处理方法。慢性INH肝毒性及INH的临床应用将单独讨论。 (参见“异烟肼的肝毒性”和“Isoniazid: An overview”)

药理学与细胞毒理学

INH对分枝杆菌有选择性抗菌活性，很可能是因为它能够抑制分枝杆菌酸的合成。这种抑制作用干扰了细胞壁的合成，从而产生杀菌作用。 (参见“Isoniazid: An overview”)

INH产生毒性的原因很多，包括缺乏维生素B6和γ-氨基丁酸(gamma amino butyric acid, GABA)。INH至少会通过两种机制来诱发功能性维生素B6不足的状态。第一，INH的代谢产物直接与维生素B6类物质结合并使其失活。第二，异烟肼可抑制维生素B6磷酸激酶，该酶在激活维生素B6转变为5-磷酸吡哆醛的过程中必不可少，而后者是很多“维生素B6依赖性”反应中的辅因子。功能性维生素B6缺乏可能是INH诱导周围神经病的机制。

                       

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Literature review current through: 2017-07 . | This topic last updated: 2016-08-23.
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