肺结核化疗过程中出现的类赫氏反应89例临床分析

An 89-case study of Herxbeimer reaction in the course of pulmonary tuberculosis chemotherapy

目的探讨类赫氏反应临床特点。方法我院2004年～2008年收治89例类赫氏反应的患者进行分析。结果年龄以青壮年初治病例居多占92%;以血行播散型肺结核发生率高占85.4%。多数发生在INH、RFP治疗1～2月占84%。临床特点以突然发高热39℃左右,乏力、盗汗、咳嗽等主要症状,占80%左右,胸片发现原病灶恶化或出现新病灶,系变态反应所致。类赫氏反应所致病灶恶化或出现新病灶以及并发胸腔积液、结脑、心包炎、肺门、纵隔、颈部等淋巴结肿大等。经1～2个月用原化疗方案大多数病例症状明显改善,病变吸收好转,并发结脑、心包炎患者3～6个月治愈,疗效甚佳。结论初治病例经用INH、RFP化疗1～2月左右症状改善,病灶吸收好转,但突发症状加重,肺内病灶恶化或出现新病灶,首先应考虑为类赫氏反应。

Objective To explore the clinical characteristic of Herxbeimer reaction. Methods Clinical data of 89 cases of herx- berimer reaction were analyzed who were admitted between the years of 2004 and 2008. Results There were 62 men and 27 women with the gender ratio of 2. 3 ： 1. The most were young and middle-aged（92% ） ,with predominating pulmonary tuberculosis by blood spreading （ 85.4% ）. The most occurred in the area of INH ,with the treatment time between 1 and 2 months（g4% ）. Eighty percent had the clinical characteristics of sudden high fever（ around 39℃ ）, asthenia, night sweating, cough, etc. X-ray showed that allergy led to the worsening of original infection area or the development of new areas. The Herxhermer reaction might lead to the worsening or the development of the new ones in the diseases of fluid in chest cavity,lymph nodes, knot brain, pericarditis,lung hilus, mediastinum, pate tumescently and so on.After 1-2 months of treatment using original chemotherapy,the most showed the obvious improvement in infected areas. After 3-6 months of treatment, the improvement was seen in the patients with knot brain and pericarditis. Conclusion The Symptoms can improve and the focus of obsortion gets better when the initial treatment use INH, and RFP chemotherapy for 1-2 months. However the symptoms suddenly become worse or new focus re-appear, we should first consider the Herxheimer reaction, which is not difficult to diagnose.