Department of Dermatology and Regional STD Center and Institute of Pathology (ICMR), Safdarjang Hospital and VM Medical College, New Delhi-110 029, India.
Indian J Dermatol Venereol Leprol. 2010 Mar-Apr;76(2):138-44. doi: 10.4103/0378-6323.60553.
BACKGROUND AND AIMS: A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients. METHODS: A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response. RESULTS: Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal. CONCLUSION: No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone.
背景和目的:本回顾性分析采用推荐剂量的葡萄糖酸锑钠(SSG)单独治疗和联合其他抗利什曼原虫药物治疗门诊就诊的成人迟发性皮肤利什曼病(PKDL)的疗效。
方法:共纳入报告中十年来就诊的 61 例患者。所有患者均存在多形性病变。诊断基于临床表现、来自利什曼病(KA)流行地区、排除其他皮肤病、组织病理学和治疗反应。患者分为两组:组 I(n=32),静脉内给予 SSG;组 II(n=29),根据 SSG 联合其他药物的使用情况分为四组。第一组(n=10),SSG 联合别嘌醇;第二组(n=6),SSG 联合利福平;第三组(n=5),SSG 联合别嘌醇和利福平;第四组(n=8),SSG 联合免疫调节剂(MW 疫苗),已知其增强宿主 Th1 反应。
结果:只有 12 例患者(61 例中的 12 例)完成了治疗,直至组织病理学治愈证据,组 I 中有 5 例,组 II 中有 7 例,无第三组患者。没有患者无中断地使用 SSG。两组患者的丘疹结节消退时间相似,但组 II 的红斑和硬结消退较早。组 I 患者在接受 120 次注射后治愈,而在 SSG+别嘌醇和 MW 疫苗组分别需要 95 次注射,在 SSG+利福平组需要 110 次注射。然而,这不足以提高患者的依从性。治疗时间长、血栓性静脉炎、静脉穿刺困难、致残性风湿性副作用和实际问题导致治疗效果差和高脱落率。肝功能、肾功能和胰腺功能以及心电图均正常。
结论:与 SSG 单独治疗相比,联合使用别嘌醇、利福平或 MW 疫苗并没有获得明显优势。
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