每日一题_2022.12.19

A 26-year-old recent immigrant from Mexico presents to the emergency department with a three-week history of fevers accompanied by night sweats and chills, weight loss of 2.3 kg (5 lb), and cough that is often productive of blood-tinged sputum. Bronchoalveolar lavage is performed and an acid-fast stain of the sample reveals the organism shown in the image. Which of the following should be included in this patient’s therapy to prevent a common toxicity of treatment?

一名26岁的最近从墨西哥移民到急诊科就诊，有三周的发热史，伴有盗汗和寒战，体重减轻2.3 kg(5 lb)，咳嗽通常咳出带血的痰。进行支气管肺泡灌洗，样本的抗酸染色显示图像中所示的微生物。该患者的治疗中应包括以下哪一项，以防止常见的治疗毒性？

(A) Cobalamin

(B) Pyridoxine

(C) Vitamin B1

(D) Vitamin C

(E) Vitamin E

答案解析：

患者疑似TB，抗酸染色显示致病微生物（结核分枝杆菌）为红色。症状包括发热、盗汗、寒战、咳嗽和体重减轻。他的治疗方案将包括异烟肼和其他抗分枝杆菌药物。异烟肼可抑制分枝杆菌细胞壁的分枝菌酸合成。由于耐药性的快速发展，异烟肼不应单独用于治疗活动性TB。异烟肼可耗尽产生多巴胺、肾上腺素、去甲肾上腺素和单胺类神经递质所需的吡哆醇（维生素B6）。因此，异烟肼治疗的不良反应之一是周围神经病变，可通过同时给予维生素 B6 来预防。

正确答案：B