Drug-induced lymphocyte stimulation test is not useful for the diagnosis of drug-induced pneumonia
Drug-induced lymphocyte stimulation test is not useful for the diagnosis of drug-induced pneumonia
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DOI：
10.1620/tjem.212.49
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发表时间：
2007-05-01
影响因子：
2.2
通讯作者：
Kumamoto, Toshihide
中科院分区：
文献类型：
--
作者：
Matsuno, Osamu;Okubo, Toshiyuki;Kumamoto, Toshihide
药物性肺炎是由某些药物引起的肺毒性，其诊断是困难的，因为大量不同的药物可以引起具有不同病理机制的各种免疫介导的疾病。药物诱导的淋巴细胞刺激试验（DLST）在日本被广泛用于诊断药物诱导的肺炎。然而，最近的报告表明，DLST是不可靠的诊断药物性肺炎。为了诊断药物性肺炎，用可疑药物进行激发试验是评估药物与肺炎之间关系的最可靠方法。我们在6例疑似药物性肺炎病例中检查了DLST与激发试验之间的相关性。所有患者均行DLST检查。所有患者的肺炎原因均通过激发试验确认。6例疑似药物性肺炎患者中3例DLST阳性，但激发试验排除了可疑药物。如果我们仅依赖于DLST，这3例病例将被标记为假性过敏。在任何病例中，DLST的结果均与激发试验的结果不一致。我们的研究结果表明，DLST是没有用的药物性肺炎的诊断。用致病药物激发后，在任何病例中均未观察到肺浸润复发。这些结果表明，仔细进行激发试验是安全和最可靠的方法。
Diagnosis of drug-induced pneumonia, which represents pulmonary toxicity caused by certain drugs, is difficult, as a large number of different drugs can elicit various immune-mediated diseases with distinct pathomechanisms. The drug-induced lymphocyte stimulation test (DLST) is widely used for diagnosing drug-induced pneumonia in Japan. Recent reports, however, indicate that DLST is not reliable for diagnosis of drug-induced pneumonia. To diagnose drug-induced pneumonia, a provocation test with the suspected drug is the most reliable method of assessing the relationship between the drug and pneumonia. We examined the correlation between the DLST and the provocation test in 6 cases of suspected drug-induced pneumonia. DLST was performed in all of the patients. The causes of pneumonia in all patients were confirmed by a provocation test. The DLST was positive in 3 of 6 cases of suspected drug-induced pneumonia, but the suspected drugs were ruled out by the provocation test. If we had relied solely on the DLST, these 3 cases would have been labeled as false allergy. The results of the DLST did not coincide with the results of the provocation test in any of the cases. Our results suggest that the DLST is not useful for the diagnosis of drug-induced pneumonia. Following provocation with the causative drug, reappearance of pulmonary infiltration was not observed in any of the cases. These findings indicate that a carefully performed provocation test is the safe and most reliable method.