Lessa H A, Machado P, Lima F, Cruz A A, Bacellar O, Guerreiro J, Carvalho E M
Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Faculdade de Medicina da Universidade Federal da Bahia, Salvador-Bahia, Brazil.
Am J Trop Med Hyg. 2001 Aug;65(2):87-9. doi: 10.4269/ajtmh.2001.65.87.
Mucosal leishmaniasis is characterized by an intense inflammatory reaction and tissue damage with few parasites in the lesion. On the basis of previous observations that suggest a possible role of tumor necrosis factor alpha (TNF-alpha) in the pathology of this disease, an open-label study was performed to evaluate the efficacy of the treatment with an inhibitor of TNF-alpha (pentoxifylline) associated to antimony therapy in 10 patients with refractory mucosal leishmaniasis. Patients were treated with pentavalent antimony (20 mg per kilogram of body weight per day) plus orally administered pentoxifylline 400 mg 3 times daily for 30 days. Nine of 10 patients fulfilled the criteria for cure: they experienced complete reepithelization of the mucosal tissue 90 days after therapy and displayed no evidence of relapse at 1 year of follow-up. The TNF-alpha levels before therapy (776 +/- 342 pg/mL) fell to 94 +/- 57 pg/mL (P < 0.05) within 60 days after therapy. Our results indicate that pentoxifylline plus antimony therapy should be considered in all patients with mucosal leishmaniasis that is refractory to treatment.
黏膜利什曼病的特征是炎症反应强烈且组织受损，但病变部位寄生虫数量较少。基于先前的观察结果表明肿瘤坏死因子α（TNF-α）可能在该疾病的病理过程中起作用，开展了一项开放标签研究，以评估TNF-α抑制剂（己酮可可碱）联合锑剂治疗10例难治性黏膜利什曼病患者的疗效。患者接受五价锑（每日每千克体重20毫克）治疗，同时口服己酮可可碱，每日3次，每次400毫克，持续30天。10例患者中有9例符合治愈标准：治疗90天后黏膜组织完全重新上皮化，且在1年的随访中无复发迹象。治疗前的TNF-α水平（776±342皮克/毫升）在治疗后60天内降至94±57皮克/毫升（P<0.05）。我们的结果表明，对于所有难治性黏膜利什曼病患者，应考虑采用己酮可可碱联合锑剂治疗。
