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，同期人院的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10ml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64．5N（20／31）、48．3N（28／58）、54．2N（13／24）和31．6N（6／19），特异度分别为93．3％（167／179）、94．7％（144／152）、97．3N（181／186）和98．4N（188／191），假阳性率分别为6．7％（12／179）、5．3％（8／152）、2．7％（5／186）和1．68（3／191），假阴性率分别为35．5％（11／31）、51．7％（30／58）、45．aN（11／24）和68．4N（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。
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 pa- tients with first treatment pulmonary tuberculosis who had adverse drug reactions were served as case group. Nine- ty-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 provoca tion 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.
出处
《中国防痨杂志》
CAS
2014年第12期1062-1066,共5页
Chinese Journal of Antituberculosis
基金
上海市卫生局青年科研基金（20124Y024）
关键词
结核
肺/药物疗法
抗结核药
药物过敏
淋巴细胞活化
Tuberculosis, pulmonary/drug therapy
Antitubercular agents
Drug hypersensitivity
Lymphocyte activation
