药物淋巴细胞刺激试验诊断抗结核药物所致超敏反应的临床价值研究

Clinical Value of the Drug Lymphocyte Stimulation Test for Diagnosis of Hypersensitivity Reactions Induced by Antitubercular Drugs

目的分析药物淋巴细胞刺激试验(DLST)诊断抗结核药物所致超敏反应的临床价值。方法选取2015年1月—2016年12月在江西省胸科医院住院的初治肺结核治疗过程中发生超敏反应的患者60例。同期选取本院初治肺结核治疗过程中未发生超敏反应的患者60例作为对照组。以药物激发试验(DPT)作为判定何种药物所致超敏反应的金标准;分析DLST对4种一线抗结核药物[异烟肼(INH)、乙胺丁醇(EMB)、利福平(RFP)、吡嗪酰胺(PZA)]所致超敏反应的诊断价值。结果 DLST诊断INH、EMB、RFP、PZA所致超敏反应的灵敏度分别为52.38%、50.00%、43.48%、58.33%,特异度分别为97.98%、99.09%、97.94%、100.00%。结论 DLST在诊断患者因何种抗结核药物所致超敏反应上具有较高的特异度,对指导临床应用抗结核药物有较大的意义。

Objective To evaluate the value of the drug lymphocyte stimulation test(DLST)for diagnosis of antitubercular drug-induced hypersensitivity.Methods The case group consisted of 60 patients who developed hypersensitivity reactions during initial anti-pulmonary tuberculosis treatment in the Jiangxi Chest Hospital between January 2015 and December 2016.Sixty patients who received initial anti-pulmonary tuberculosis treatment who experienced no hypersensitivity reactions during the same period were selected as the control group.The drug provocation test(DPT)was used as the gold standard to determine which drug induced hypersensitivity.The value of the DLST for identifying hypersensitivity-inducing drugs among four major anti-TB drugs,isoniazid(INH),ethambutol(EMB),rifampicin(RFP)and pyrazinamide(PZA),was evaluated.Results The sensitivities of the DLST in diagnosis of hypersensitivity reactions induced by INH,EMB,RFP and PZA were 52.38%,50.00%,43.48%and 58.33%,respectively,and the specificities were 97.98%,99.09%,97.94%and 100.00%,respectively.Conclusion The DLST has high specificity in identification of hypersensitivity-inducing antitubercular drugs and provides valuable guidance for their clinical application.