Rea T H, Sieling P A
Division of Dermatology, University of Southern California School of Medicine, Los Angeles 90033, USA.
Int J Lepr Other Mycobact Dis. 1998 Sep;66(3):316-27.
Reported herein are 13 borderline lepromatous (BL) or subpolar lepromatous (LLs) patients who presented with or developed delayed-type hypersensitivity (DTH) reactions after initiation of antibacterial therapy, but who subsequently developed erythema nodosum leprosum (ENL), the DTH to ENL group. During the same time, three LLs patients had ENL followed by relapse-associated DTH, a significant (p < 0.05) difference in sequence of the two conditions. The DTH to ENL group had statistically significant higher biopsy indexes at the time of diagnosis of the DTH reaction compared with two DTH control groups, 7 multibacillary patients presenting with DTH reactions and 15 BL or LLs who developed DTH reactions after starting treatment but had no ENL. DTH-associated histologic changes were less well developed in the DTH to ENL group than in either of the two control groups. In the DTH to ENL group, 77% required prednisone in addition to thalidomide to achieve a complete remission in contrast to only 10% of 21 ENL clinical controls. In the DTH to ENL group, the classical histologic ENL pattern was present in only 31% of these patients, in contrast to 88% of 33 ENL histologic controls. In 9 of 9 of the DTH to ENL patients studied, after the ENL remitted, Mycobacterium leprae-sonicate-stimulated lymphocyte transformation tests gave stimulation indexes within the range of our tuberculoid (TT) and borderline tuberculoid (BT) patients, in contrast to absent responses in 6 ordinary, longterm-treated patients who had had ENL.
本文报告了13例边缘型瘤型（BL）或亚极型瘤型（LLs）患者，他们在开始抗菌治疗后出现或发生了迟发型超敏反应（DTH），但随后发展为结节性红斑麻风反应（ENL），即DTH转ENL组。同时，3例LLs患者先出现ENL，随后出现与复发相关的DTH，这两种情况的发生顺序有显著差异（p<0.05）。与两个DTH对照组相比，DTH转ENL组在诊断DTH反应时的活检指数在统计学上显著更高，两个对照组分别为7例出现DTH反应的多菌型患者以及15例开始治疗后出现DTH反应但无ENL的BL或LLs患者。DTH转ENL组中与DTH相关的组织学变化不如两个对照组中的任何一组明显。在DTH转ENL组中，77%的患者除沙利度胺外还需要泼尼松才能实现完全缓解，相比之下，21例ENL临床对照患者中只有10%需要。在DTH转ENL组中，只有31%的患者呈现出经典的组织学ENL模式，相比之下，33例ENL组织学对照患者中有88%呈现该模式。在研究的9例DTH转ENL患者中，ENL缓解后，麻风分枝杆菌超声裂解物刺激的淋巴细胞转化试验的刺激指数在我们的结核样型（TT）和边缘结核样型（BT）患者范围内，相比之下，6例接受长期治疗且曾患ENL的普通患者无反应。
