Pépin J, Milord F, Khonde A N, Niyonsenga T, Loko L, Mpia B, De Wals P
Université de Sherbrooke, Canada.
Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):92-7. doi: 10.1016/0035-9203(95)90673-8.
This paper reviews the incidence of, and risk factors for, drug-induced encephalopathy and mortality (from all causes) during treatment with melarsoprol of 1083 patients with Trypanosoma brucei gambiense sleeping sickness in Nioki hospital (Zaire) between 1983 and 1990. Sixty-four patients (5.9%) developed encephalopathy and 62 (5.7%) died: 43 from reactive encephalopathy and 19 from other causes. Univariate and multivariate analyses showed that the administration of prednisolone reduced significantly the incidence of encephalopathy and mortality during treatment, especially in patients with trypanosomes observed in the cerebrospinal fluid (CSF) and/or with a CSF white blood cell (WBC) count of 100 or more per mm3. The risk of encephalopathy was associated more strongly with the CSF WBC count than with the presence of CSF trypanosomes. In the subgroup of patients with a CSF WBC count of 100 or more mm3, changing the melarsoprol regimen to 3 series of 3 injections instead of 3 series of 4 injections halved the mortality rate during treatment. Treatment of patients who do develop reactive encephalopathy with the heavy metal chelator dimercaprol, in addition to intravenous steroids and anticonvulsants, may be harmful. The data suggest that a further reduction of the total dose of melarsoprol may decrease toxicity without jeopardizing efficacy.
本文回顾了1983年至1990年间在扎伊尔尼奥基医院接受美拉胂醇治疗的1083例布氏冈比亚锥虫昏睡病患者药物性脑病的发病率、危险因素以及全因死亡率。64例患者（5.9%）发生脑病，62例（5.7%）死亡：43例死于反应性脑病，19例死于其他原因。单因素和多因素分析表明，泼尼松龙的使用显著降低了治疗期间脑病的发病率和死亡率，尤其是在脑脊液（CSF）中发现锥虫和/或脑脊液白细胞（WBC）计数每立方毫米100个或更多的患者中。脑病的风险与脑脊液白细胞计数的相关性比与脑脊液中锥虫的存在更强。在脑脊液白细胞计数每立方毫米100个或更多的患者亚组中，将美拉胂醇治疗方案从3组4次注射改为3组3次注射可使治疗期间的死亡率减半。除静脉注射类固醇和抗惊厥药外，用重金属螯合剂二巯丙醇治疗确实发生反应性脑病的患者可能有害。数据表明，进一步降低美拉胂醇的总剂量可能会降低毒性而不影响疗效。
