2024 年第 10 期 第 19 卷

利奈唑胺致极重度乳酸酸中毒1例报道及文献复习

A case study and analysis of the literature on extremely severe lactic acidosis brought on by linezolid

作者：邓炀李璟昊卢婷婷康福新

英文作者：Deng Yang Li Jinghao Lu Tingting Kang Fuxin

单位：海南医学院第二附属医院重症医学科，海口570311

英文单位：Department of Critical Care Medicine the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：利奈唑胺；乳酸酸中毒；结核性胸膜炎；休克

英文关键词：Linezolid;Lacticacidosis;Tuberculouspleurisy;Shock

• 摘要：

• 利奈唑胺是一种噁唑烷酮类抗菌药物，其作用机制主要是通过靶向细菌核糖体和干扰细菌蛋白质合成来抑制细菌生长，主要用于治疗革兰阳性菌感染，包括对万古霉素具有耐药性的屎肠球菌、金黄色葡萄球菌以及对甲氧西林具有耐药性的金黄色葡萄球菌。尽管利奈唑胺是一种有效的抗菌药物，但其可能引起的乳酸酸中毒是一种罕见且致命的不良反应。目前治疗指南推荐：①在使用利奈唑胺时监测血利奈唑胺和乳酸水平。②利奈唑胺不宜与影响线粒体功能的药物合用。③肝肾功能不全或利奈唑胺治疗＞1个月的患者应监测高乳酸血症。④若出现高乳酸酸中毒，建议尽快停用利奈唑胺并纠正酸中毒。本文报告1例服用利奈唑胺治疗结核性胸膜炎后出现乳酸酸中毒的病例，经排除代谢、缺氧或器官损伤等其他原因后，确认该症状为利奈唑胺不良反应，旨在提升临床医师对利奈唑胺引起乳酸酸中毒的诊疗认知。

• Linezolid is an oxazolidinone antibacterial drug whose mechanism of action is mainly to inhibit bacterial growth by targeting bacterial ribosomes and interfering with bacterial protein synthesis, and is mainly used for the treatment of gram-positive bacteria, including Enterococcus faecalis, Staphylococcus aureus, and Staphylococcus aureus resistant to vancomycin. Although linezolid is an effective antimicrobial drug, its potential to cause lactic acidosis is a rare and fatal side effect. Current treatment guidelines have some recommendations. First, monitor blood linezolid and lactate levels while linezolid is being administered. Second, linezolid should not be combined with drugs that affect mitochondrial function. Third, patients with hepatic and renal insufficiency or linezolid therapy for >1 month should be monitored for hyperlactatemia. Fourth, if hyperlactic acidosis occurs, it is recommended to stop linezolid and correct the acidosis as soon as possible. This article reports a case of lactic acidosis after taking linezolid for tuberculous pleurisy, which was confirmed to be a side effect of linezolid after exclusion of other causes such as metabolism, hypoxia or organ damage. It aims to improve clinicians′ knowledge of the diagnosis and treatment of lactic acidosis caused by linezolid.