Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy
Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy
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DOI：
10.1378/chest.128.4.2218
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发表时间：
2005-10-01
期刊：
影响因子：
9.6
通讯作者：
Yim, JJ
中科院分区：
文献类型：
--
作者：
Kim, DK;Lee, SW;Yim, JJ
研究目的：探讨抗癌化疗患者并发肺结核的临床特点及治疗反应。设计：回顾性病例对照研究。地点：韩国首尔国立大学医院，韩国第三转诊医院。患者：2000年1月1日至2004年7月31日，以抗癌化疗中发现的肺结核患者为研究对象。选择年龄和性别匹配的无任何恶性疾病的结核病患者作为对照对象。测量和结果：纳入24例患者和48例对照组。平均年龄+/-SD为56.3±14.3岁，男女之比为3：1。最常见的恶性肿瘤为胃癌(43%)。淋巴瘤(17%)、肺癌(8%)和头颈癌(8%)也很常见。在两组患者中，肺是最常见的肺结核受累部位(回顾时，分别为87.8%和79.2%)。在接受抗癌化疗的肺结核患者中，放射学上提示陈旧性肺结核的疤痕组织的存在更为常见(66.7%比43.8%，p=0.07)。两组之间的放射学严重程度没有差异。在所有受试者中开始了以一线抗结核药物为基础的治疗方案。合并抗癌化疗的肺结核患者完成预期抗结核化疗的频率较低(58.3%vs79.2%，p=0.02)，但在排除潜在恶性肿瘤进展造成的损失后，这一比例并无差异。两组对治疗的细菌学/放射学反应以及足以改变或停止治疗的抗结核药物的毒性没有差异。结论：在抗结核治疗的X线和临床反应方面，抗癌化疗期间发生的结核病与普通情况下发生的结核病在临床上没有什么不同。这项研究的发现表明，抗癌化疗并不是治疗结核病的障碍。
Study objectives: The aim of this study was to elucidate the clinical characteristics and treatment responses of tuberculosis developing in patients receiving anticancer chemotherapy.Design: Retrospective case-control study.Setting: The Seoul National University Hospital, a tertiary referral hospital in South Korea.Patients: From January 1, 2000, to July 31, 2004, patients with tuberculosis detected during the course of anticancer chemotherapy were enrolled as cases. Age- and sex-matched tuberculosis patients without any malignant disease were selected as control subjects.Measurements and results: Twenty-four patients and 48 control subjects were enrolled. Their mean +/- SD age was 56.3 +/- 14.3 years, and the male-to-female ratio was 3:1. The most common malignancy was gastric cancer (43%). Lymphoma (17%), lung cancer (8%), and head and neck cancer (8%) were also common. In both groups, the lung was the most common site of tuberculosis involvement (87.8% and 79.2%, retrospectively). The presence of scar tissue suggesting old tuberculosis on radiography was more common in patients with tuberculosis receiving anticancer chemotherapy (66.7% vs 43.8%, p = 0.07). No difference in radiographic severity was observed between groups. A regimen based on first-line antituberculosis drugs was started in all subjects. Frequency of completion of the expected antituberculosis chemotherapy was lower in patients with tuberculosis developing with anticancer chemotherapy (58.3% vs 79.2%, p = 0.02), but it was not different after excluding the loss due to progression of underlying malignancies. Bacteriologic/radiographic responses to treatment and toxicity of antituberculosis medication sufficient to change or stop treatment were not different in both groups.Conclusions: With regard to radiographic and clinical responses to antituberculosis treatment, tuberculosis developing during anticancer chemotherapy is not clinically different from tuberculosis developing in ordinary situations. Findings in this study suggest that anticancer chemotherapy is not an obstacle in treating tuberculosis.