Alhashimi M M, Citron M L, Fossieck B E, Steinberg S M, Johnston-Early A, Krasnow S H, Cohen M H
Oncology Section, VA Medical Center, Washington, DC.
South Med J. 1988 Mar;81(3):337-40. doi: 10.1097/00007611-198803000-00013.
We determined the incidence of tuberculosis in lung cancer patients with known tuberculin status. All patients received chemotherapy with or without radiation therapy, corticosteroid therapy, or both, and none received isoniazid prophylaxis. Positive tuberculin reactivity was found in 89 of the 257 patients; among these 89, tuberculosis developed in one patient before and in one patient after chemotherapy. Among the other 168 patients, one case of tuberculosis developed after chemotherapy. For all lung cancer patients, the incidence of tuberculosis was higher than age-specific and race-specific rates in a control population. The risk of tuberculosis was judged to be significantly higher in patients with positive than with negative tuberculin reactivity; among tuberculin reactors, however, the risk of tuberculosis was estimated to be less than the potential risk of isoniazid hepatotoxicity reported in the literature for patients in a similar age group. The median survival for tuberculin-positive lung cancer patients was 9.6 months. Because of the limited survival in these patients, and because of the high risk of isoniazid hepatotoxicity for patients in this age group, we do not recommend isoniazid prophylaxis for tuberculin-positive patients receiving chemotherapy for lung cancer.
我们确定了结核菌素状态已知的肺癌患者中结核病的发病率。所有患者均接受了化疗，部分患者还接受了放疗、皮质类固醇治疗或两者兼用，且无人接受异烟肼预防治疗。257例患者中，89例结核菌素反应呈阳性；在这89例患者中，1例在化疗前、1例在化疗后发生了结核病。在其他168例患者中，1例在化疗后发生了结核病。对于所有肺癌患者，结核病发病率高于对照人群中按年龄和种族划分的发病率。结核菌素反应呈阳性的患者发生结核病的风险被判定显著高于反应呈阴性的患者；然而，在结核菌素反应阳性者中，结核病风险估计低于文献报道的类似年龄组患者异烟肼肝毒性的潜在风险。结核菌素阳性的肺癌患者中位生存期为9.6个月。由于这些患者生存期有限，且该年龄组患者发生异烟肼肝毒性的风险较高，因此我们不建议对接受肺癌化疗的结核菌素阳性患者进行异烟肼预防治疗。
