Selective increase in plasma tumor necrosis factor-α and concomitant clinical deterioration after initiating therapy in patients with severe tuberculosis
Selective increase in plasma tumor necrosis factor-α and concomitant clinical deterioration after initiating therapy in patients with severe tuberculosis
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DOI：
10.1086/517479
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发表时间：
1998-08-01
影响因子：
6.4
通讯作者：
Kaplan, G
中科院分区：
文献类型：
--
作者：
Bekker, LG;Maartens, G;Kaplan, G
严重结核病患者开始抗结核治疗可能伴随着临床恶化，甚至在出现任何改善之前死亡。为了研究这一现象，对新诊断的人类免疫缺陷病毒阴性成人严重结核病患者进行了为期42天的标准短程治疗。在第0、3和7天监测临床状态、血清乳酸盐、血浆细胞因子和血浆细胞因子受体水平，然后每周监测一次，持续42天。抗结核治疗7天后，观察到平均Karnofsky评分显著一过性降低（P <0.001），血清乳酸升高（P = 0.06），患者体重减轻（P = 0.02），血浆肿瘤坏死因子-α（TNF-α）浓度升高（P = 0.04）。在42天的研究期间，可溶性白细胞介素-2受体、干扰素-γ、白细胞介素-6和TNF-α受体的血浆水平降低。这些观察结果表明，血浆TNF-α水平的增加可能与严重结核病治疗早期观察到的临床恶化有关。
The initiation of antituberculosis treatment in patients with severe tuberculosis may be accompanied by clinical deterioration and even death before any improvement occurs. To investigate this phenomenon newly diagnosed human immunodeficiency virus-negative adults with severe tuberculosis were followed for the first 42 days of standard short-course therapy. Clinical status, serum lactate, plasma cytokine, and plasma cytokine receptor levels were monitored on days 0, 3, and 7 and then weekly for up to 42 days. Following 7 days of antituberculosis therapy, a significant transient decrease in mean Karnofsky score (P < .001), a concomitant increase in serum lactate (P = .06), a decrease in patient weight (P = .02), and an increase in plasma tumor necrosis factor-alpha (TNF-alpha) concentrations (P =.04) were observed. Plasma levels of soluble interleukin-2 receptor, interferon-gamma, interleukin-6, and TNF-alpha receptor decreased over the 42-day study period. These observations suggest that increases in plasma TNF-alpha levels may be associated with clinical deterioration observed early in the treatment of severe tuberculosis.