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[抗结核药物过敏反应的脱敏治疗——根据日本结核病学会指南对脱敏治疗的评估]

[Desensitization therapy for allergic reactions of antituberculous drugs--evaluation of desensitization therapy according to the guideline of the Japanese Society for Tuberculosis].

作者信息

Kobashi Y, Okimoto N, Matsushima T, Abe T, Nishimura K, Shishido S, Kawahara S, Shigeto E, Takeyama H, Kuraoka T

机构信息

Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School Kawasaki Hospital, Japan.

出版信息

Kekkaku. 2000 Dec;75(12):699-704.

Abstract

We prospectively evaluated the effectiveness of desensitization therapy for cases showing side-effects to antituberculous drugs (Isoniazid and Rifampicin) according to the guideline proposed by the Treatment Committee of the Japanese Society for Tuberculosis. Nineteen patients (23-88 years old, male 9, female 10) who had experienced adverse effects after receiving antituberculous drugs and underwent desensitization therapy between August 1998 and March 2000 were studied. Underlying diseases were 14 cases of pulmonary tuberculosis, 2 cases of cervical tuberculous lymphadenitis, 1 case of pulmonary atypical mycobacteriosis, 1 case of pulmonary tuberculosis and tuberculous pleuritis, 1 case of pulmonary tuberculosis and tuberculous lymphadenitis. The regimens of treatment for tuberculosis were INH + RFP + EB in 8 cases, INH + RFP + EB + PZA in 7 cases, INH + RFP + SM in 2 cases, INH + RFP + SM + PZA in 1 case, and INH + RFP in 1 case. Adverse reactions were 8 cases of eruption, 7 cases of drug fever, 3 cases of drug fever and eruption, and 1 case of drug fever and cervical lymphadenopathy. The causative drugs suggested from DLST or the clinical course were RFP in 17 cases and INH in 8 cases. The clinical effect of desensitization therapy for these antituberculous drugs was good in 14 out of the 17 cases (82%) for RFP, and in 6 out of 8 cases (75%) for INH. The effectiveness rate of the present desensitization therapy according to the guideline of the Japanese Society for Tuberculosis was almost equal to that of previous desensitization therapy, and the clinical results were almost same in present and previous studies despite the different methods of administration of the antituberculous drugs.

摘要

我们根据日本结核病协会治疗委员会提出的指南,对显示对抗结核药物(异烟肼和利福平)有副作用的病例进行了脱敏治疗效果的前瞻性评估。研究对象为1998年8月至2000年3月期间接受抗结核药物治疗后出现不良反应并接受脱敏治疗的患者(年龄23 - 88岁,男性9例,女性10例)。基础疾病包括肺结核14例、颈部结核性淋巴结炎2例、肺部非典型分枝杆菌病1例、肺结核合并结核性胸膜炎1例、肺结核合并结核性淋巴结炎1例。结核病的治疗方案为:8例采用异烟肼 + 利福平 + 乙胺丁醇,7例采用异烟肼 + 利福平 + 乙胺丁醇 + 吡嗪酰胺,2例采用异烟肼 + 利福平 + 链霉素,1例采用异烟肼 + 利福平 + 链霉素 + 吡嗪酰胺,1例采用异烟肼 + 利福平。不良反应包括皮疹8例、药物热7例、药物热合并皮疹3例、药物热合并颈部淋巴结病1例。从药物淋巴细胞刺激试验(DLST)或临床病程推测的致病药物为利福平17例、异烟肼8例。对于这些抗结核药物,脱敏治疗的临床效果在利福平17例中有14例(82%)良好,在异烟肼8例中有6例(75%)良好。根据日本结核病协会指南进行的本次脱敏治疗有效率与以往脱敏治疗几乎相同,尽管抗结核药物的给药方法不同,但本次和以往研究的临床结果几乎相同。

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