药物淋巴细胞刺激试验对于诊断抗结核药物所致超敏反应的价值及意义

doi:10.3969/j.issn.1000-6621.2014.12.012

中国防痨杂志 ›› 2014, Vol. 36 ›› Issue (12): 1062-1066.doi: 10.3969/j.issn.1000-6621.2014.12.012

药物淋巴细胞刺激试验对于诊断抗结核药物所致超敏反应的价值及意义

孙勤沙巍桂徐蔚曾维宏肖洋炯肖和平

200433 同济大学附属上海市肺科医院结核病诊疗中心上海市结核病（肺）重点实验室（孙勤、沙巍、桂徐蔚、肖和平）；上海交通大学医学院免疫学研究所（曾维宏、肖洋炯）

收稿日期:2014-08-04 出版日期:2014-12-10 发布日期:2015-02-28
通信作者: 沙巍 E-mail:shfksw@126.com
基金资助:
上海市卫生局青年科研基金（20124Y024）

The value of drug-induced lymphocyte stimulation test for the diagnosis of anti-tuberculous drug-induced hypersensitivity reaction

SUN Qin, SHA Wei, GUI Xu-wei, ZENG Wei-hong, XIAO Yang-jiong,XIAO He-ping

Tuberculosis Diagnosis and Treatment Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China

Received:2014-08-04 Online:2014-12-10 Published:2015-02-28
Contact: SHA Wei E-mail:shfksw@126.com

摘要/Abstract

摘要： 目的评价药物淋巴细胞刺激试验（DLST）对确定因何种抗结核药物所致超敏反应的诊断价值。方法 2010年8月至2012年7月期间，上海市肺科医院收治的114例抗结核药物治疗后发生超敏反应的初治肺结核患者作为超敏反应组，同期入院的96例抗结核药物治疗后未发生超敏反应的初治肺结核患者作为对照组，各抽取外周静脉血10 ml进行DLST，并与“金标准”药物激发试验（DPT）结果相比较，计算DLST的敏感度、特异度、假阳性率和假阴性率。结果 114例超敏反应组共发生了127例次超敏反应，其中药物性皮疹37例次，药物性肝损伤65例次，药物热25例次。DLST对诊断4种一线抗结核药物（INH、RFP、EMB、PZA）引起超敏反应的敏感度分别为64.5%（20/31）、48.3%（28/58）、54.2%（13/24）和31.6%（6/19），特异度分别为93.3%（167/179）、94.7%（144/152）、97.3%（181/186）和98.4%（188/191），假阳性率分别为6.7%（12/179）、5.3%（8/152）、2.7%（5/186）和1.6%（3/191），假阴性率分别为35.5%（11/31）、51.7%（30/58）、45.8%（11/24）和68.4%（13/19）。结论 DLST对于诊断因何种抗结核药物所致超敏反应具有较高的特异度与较低的敏感度，对于指导临床有一定的意义。

关键词: 结核, 肺/药物疗法, 抗结核药, 药物过敏, 淋巴细胞活化

Abstract: Objective To evaluate the value of drug-induced lymphocyte stimulation test (DLST) for the dia-gnosis of anti-tuberculosis (TB) drug-induced hypersensitivity reaction. Methods One hundred and fourteen patients with first treatment pulmonary tuberculosis who had adverse drug reactions were served as case group. Ninety-six patients without adverse drug reactions were served as control group. After the DLST was completed, the sensitivity, specificity, false positive rate and false negative rate were compared with “gold standard” drug provocation test (DPT) for each reaction event and each drug. Results Of 114 patients in case group, a total of 127 times of anti-TB drug-associated adverse reactions occurred, including 37 cases of drug rash, 65 cases of drug-induced liver injury, and 25 cases of drug-associated fever. The sensitivities of DLST in the diagnosis of hypersensitivity reactions induced by isoniazid (INH), rifampicin (RFP), ethambutol (EMB), and pyrazinamide (PZA) were 64.5% (20/31), 48.3% (28/58), 54.2% (13/24) and 31.6% (6/19), respectively. Their specificities were 93.3% (167/179), 94.7% (144/152), 97.3% (181/186) and 98.4% (188/191), respectively. Their false-positive rates were 6.7% (12/179), 5.3% (8/152), 2.7% (5/186) and 1.6% (3/191), respectively. Their false-negative rates were 35.5% (11/31), 51.7% (30/58), 45.8% (11/24) and 68.4% (13/19), respectively. Conclusion DLST have high specificity and limited sensitivity in the diagnosis of anti-TB drug-induced hypersensitivity reaction, and is helpful for the clinicians to predict the causative drugs.

Key words: Tuberculosis, pulmonary/drug therapy, Antitubercular agents, Drug hypersensitivity, Lymphocyte activation

孙勤，沙巍，桂徐蔚，曾维宏，肖洋炯，肖和平. 药物淋巴细胞刺激试验对于诊断抗结核药物所致超敏反应的价值及意义[J]. 中国防痨杂志, 2014, 36(12): 1062-1066. doi: 10.3969/j.issn.1000-6621.2014.12.012

SUN Qin, SHA Wei, GUI Xu-wei, ZENG Wei-hong, XIAO Yang-jiong,XIAO He-ping. The value of drug-induced lymphocyte stimulation test for the diagnosis of anti-tuberculous drug-induced hypersensitivity reaction[J]. Chinese Journal of Antituberculosis, 2014, 36(12): 1062-1066. doi: 10.3969/j.issn.1000-6621.2014.12.012

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药物淋巴细胞刺激试验对于诊断抗结核药物所致超敏反应的价值及意义

The value of drug-induced lymphocyte stimulation test for the diagnosis of anti-tuberculous drug-induced hypersensitivity reaction

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