利福平对高血压患者降压药物效果的影响1例报告及文献复习

doi:10.13481/j.1671-587x.20190236

摘要/Abstract

摘要： 目的：探讨同时应用利福平和降压药物患者血压异常升高病例的诊疗过程，分析利福平与降压药物的相互作用，提高临床医生对该类患者用药的认识。方法：收集1例同时服用利福平和降压药物患者的临床资料，分析患者血压变化与药物的关系，结合相关文献，观察利福平作用后二氢吡啶类钙离子拮抗剂血药浓度的变化。结果：患者，男性，58岁，因咳嗽、咳痰1个月入院。入院前患者被明确诊断为肺结核、高血压，同时服用利福平、异烟肼、乙胺丁醇、吡嗪酰胺和非洛地平，入院后继续原治疗方案并予以监测血压。抗结核病治疗第9天患者出现头晕和胸闷，血压剧烈波动，予以停用利福平、调整降压药物等对症支持治疗。患者血压波动初期，联合血管紧张素转换酶抑制剂及加强二氢吡啶类钙拮抗剂用量的治疗并未使血压升高得到控制，停用利福平后36h血压开始明显下降，于抗结核治疗第18天恢复原降压方案治疗，患者血压保持稳定。结论：利福平有时可明显降低降压药物（如二氢吡啶类钙拮抗剂）的降压效果，应引起临床医生的重视。

关键词: 利福平, 高血压, 非洛地平, 盐酸贝那普利, 苯磺酸氨氯地平, 病例报告

Abstract: Objective: To discuss the diagnosis and treatment process of abnormally elevated blood pressure in the patient treated with rifampicin and antihypertensive drugs, to analyze the interaction between rifampicin and antihypertensive drugs, and to improve the clinicians' understanding of the administration in the patients.Methods: The clinical materials of a patient treated with rifampicin and antihypertensive drugs were collected,and the relationship between the blood pressure change and drug was analyzed.The changes of concentrations of dihydropyridine-based calcium antagonists after administration of rifampin were observed and the relative literatures were reviewed.Results: A 58-year-old man with coughing and coughing for 1 month was admitted to hospital.The patient was definitely diagnosed as tuberculosis and hypertension before admission;the patient was treated with rifampicin, isoniazid, ethambutol, pyrazinamide, and felodipine together.The original treatment plan was continued and the blood pressure of the patient was monitored.On the 9th day of anti-tuberculosis treatment, the patient developed dizziness, chest tightness, and severe fluctuations in blood pressure.Then rifampicin was stopped and antihypertensive drugs were adjusted.At the beginning of blood pressure fluctuation of the patient, the combination of angiotensin-converting enzyme inhibitors and the increasing dose of dihydropyridine-based calcium antagonists did not control the blood pressure.The blood pressure began to decrease significantly at 36 h after rifampin was stopped.On the 18th day of anti-tuberculosis treatment, the original antihypertensive plan was restored and the blood pressure remained stable.Conclusion: Rifampicin can sometimes significantly reduce the effect iveness of antihypertensive drugs (such as dihydropyridine calcium antagonists), and the clinicians should pay attention to it.

Key words: rifampin, hypertension, felodipine, benazepril hydrochloride, amlodipine besylate, case report

中图分类号:

R544.1

钱楚岳, 宋君莉, 刘乃萌, 孙珉丹. 利福平对高血压患者降压药物效果的影响1例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(02): 418-421.

QIAN Chuyue, SONG Junli, LIU Naimeng, SUN Mindan. Influence of rifampin in effectiveness of antihypertensive drugs in patients with hypertension: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(02): 418-421.

参考文献

[1] 国家卫生计生委合理用药专家委员会,中国医师协会高血压专业委员会.高血压合理用药指南(第2版)[J].中国医学前沿杂志:电子版,2017,7:28-126.
[2] 张正冬,张海燕,林存智.WHO第四版结核病治疗指南解读[J].中华临床医师杂志,2014,8(23):4251-4253.
[3] 中华医学会结核病学分会,抗结核药物超说明书用法专家共识编写组.抗结核药物超说明书用法专家共识[J].中华结核和呼吸杂志,2018,6:447-460.
[4] 李国境,才江平,魏宁.利福平致血压升高12例临床分析[J].宁夏医科大学学报,2018,40(4):460-461.
[5] 张慧清,李博卷.利福平引起高血压病患者血压改变46例临床观察[J].实用医技杂志,2018,25(10):1157-1158.
[6] 中华人民共和国卫生部.布鲁氏菌病诊疗指南(试行)[J].传染病信息,2012,25(6):323-324,359.
[7] GORSKI J C,VANNAPRASAHT S,HAMMAN M A,et al.The effect of age,sex,and rifampin administration on intestinal and hepatic cytochrome P4503A activity[J].Clin Pharmacol Ther,2003,74(3):275-287.
[8] XU Y,ZHOU Y,HAYASHI M,et al.Simulation of clinical drug-drug interactions from hepatocyte CYP₃A4 induction data and its potential utility in trial designs[J].Drug Metab Dispos,2011,39(7):1139-1148.
[9] WILLIAMSON K M,PATTERSON J H,MCQUEEN R H,et al.Effects of erythromycin or rifampin on losartan pharmacokinetics in healthy volunteers[J].Clin Pharmacol Ther,1998,63(3):316-323.
[10] 刘超,应颖秋.1例利福平与氨氯地平相互作用的病例分析[J].临床药物治疗杂志,2017,15(3):75-77.
[11] CORDEANU E M,GAERTNER S,FALLER A,et al.Rifampicin reverses nicardipine effect inducing uncontrolled essential hypertension[J].Fundam Clin Pharmacol,2017,31(5):587-589.
[12] 王成章,蔡长春.赖诺普利与利福平合用致持续高血压一例[J].中华老年医学杂志,1999,18(3):169.
[13] 甘道京,彭强,苏海.如何为合并结核病的高血压患者合理选择降压药物[J].中华高血压杂志,2014,22(4):301-303.
[14] KIM H I,KIM T H,Kim H,et al.Effect of rifampin on thyroid function test in patients on levothyroxine medication[J].PLoS ONE,2017,12(1):e0169775.
[15] ZHI J G,ZHAI S P,GEORGY A,et al.Exploratory effects of a strong CYP₃A inhibitor (ketoconazole),a strong CYP₃A inducer (rifampicin),and concomitant ethanol on piragliatin pharmacokinetics and pharmacodynamics in type 2 diabetic patients[J].J Clin Pharmacol,2016,56(5):548-554.
[16] MENDELL J,CHEN S Q,HE L,et al.The effect of rifampin on the pharmacokinetics of edoxaban in healthy adults[J].Clin Drug Investig,2015,35(7):447-453.
[17] YAMAZAKI S,JOHNSON T R,SMITH B J.Prediction of drug-drug interactions with crizotinib as the CYP₃A substrate using a physiologically based pharmacokinetic model[J].Drug Metab Dispos,2015,43(10):1417-1429.
[18] BEUMER J H,PILLAI V C,PARISE R A,et al.Human hepatocyte assessment of imatinib drug-drug interactions-complexities in clinical translation[J].Br J Clin Pharmacol,2015,80(5):1097-1108.
[19] LILJA J J,JUNTTI-PATINEN L,NEUVONEN P J.Effect of rifampicin on the pharmacokinetics of atenolol[J].Basic Clin Pharmacol Toxicol,2006,98(6):555-558.
[20] 陈鲁原.高血压药物治疗原则及优化[J].中国实用内科杂志,2019,39(1):19-22.
[21] 赵连友.重视个体化联合用药治疗高血压的临床价值[J].中国实用内科杂志,2019,39(1):1-4.
[22] 孙平,吴广胜,梁迅.RITP患者血浆中利福平依赖性抗血小板抗体的特性及其作用机制[J].解放军医学杂志,2017,42(5):413-419.
[23] CHOI J S,CHOI I,CHOI D H.Effects of nifedipine on the pharmacokinetics of repaglinide in rats:possible role of CYP₃A4 and P-glycoprotein inhibition by nifedipine[J].Pharmacol Rep,2013,65(5):1422-1430.