Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Paradoxical Response Developed during the Antituberculous Treatment in Tuberculous Pleurisy

결핵흉막염 치료 중에 발생한 역설적 반응에 대한 연구

  • Song, Eun Ju (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Baek, Dae Hyun (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Jung, Jun Young (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Sang Ryul (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Myong Ha (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Sung Hyuk (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Jae Hyung (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Ki Deok (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Lee, Byoung Hoon (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University) ;
  • Kim, Sang Hoon (Department of Internal Medicine, Eulji Hospital, College of Medicine, Eulji University)
  • 송은주 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 백대현 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 정준영 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이상렬 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이명하 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이성혁 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이재형 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이기덕 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 이병훈 (을지대학교 의과대학 을지병원 내과학교실) ;
  • 김상훈 (을지대학교 의과대학 을지병원 내과학교실)
  • Received : 2008.04.29
  • Accepted : 2008.06.02
  • Published : 2008.06.30
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Abstract

Background: A paradoxical response is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion after initial improvement during theprocess of antituberculous treatment. The related factors for the development of a paradoxical response in patients with tuberculous pleurisy are not certain. Methods: We selected patients with tuberculous pleurisy who had been treated for more than 4 months. The changes onthe serial chest X-ray findings before and after treatment were reviewed. Paradoxical responses were regarded as any worsening or development of new lesion at least 2 weeks after the initiation of treatment. The baseline clinical characteristics and laboratory findings of the peripheral blood and pleural fluid were compared between the patients with a paradoxical response and the patients without a paradoxical response. Results: Paradoxical responses appeared in sixteen patients (21%) among the 77 patients.It took a mean of 38.6 days after the treatment and the time to resolve the paradoxical response was a mean of 32.1 days. For the patients with a paradoxical response, the median age was younger (30.5 years vs 39.0 years, respectively) and the lymphocytic percentage of white blood cells in the pleural fluid was higher (82.1% vs 69.6%, respectively) than for the patients without a paradoxical response. Conclusion: The development of a paradoxical response during the treatment of patients with tuberculous pleurisy was not rare and this was related with the age of the patients and the percentage of lymphocytic white blood cells in the pleural fluid.

연구배경: 결핵환자에서 항결핵제 치료 중 초기에 병변의 호전 이후 방사선학적, 임상적으로 이전의 병변이 악화 되거나 새로운 병변이 발생하는 경우를 역설적 반응이라 정의한다. 결핵흉막염에서의 역설적 반응 발생과 이와 관련된 인자에 대해서 알려진 바는 많지 않다. 방 법: 2004년 1월부터 2006년 12월까지 결핵흉막염으로 진단받고 4개월 이상 항결핵제를 복용한 환자를 대상으로 하였다. 항결핵제 투약 전과 투약 후 흉부 방사선의 변화를 연속적으로 살펴보고 치료시작 2주 후에 이전의 병변의 악화나 새로운 병변이 생긴 경우를 역설적 반응이 발생한 것으로 판정하였다. 역설적 반응군이 발생하였던 환자군과 발생하지 않았던 환자군 간의 임상적인 특성과 흉수, 혈액 검사를 비교하였다. 결 과: 대상환자 77명 중 역설적 반응을 보인 환자는 16명(21%)이었다. 역설적 반응을 보인 시기는 항결핵제 사용 후 평균 38.6일이었으며, 병변의 크기가 줄어드는데 걸리는 시간은 평균 32.1일이었다. 역설적 반응은 젊은환자에서(30.5세 vs 39.0세), 그리고 흉수의 백혈구 중 림프구의 백분율이 높았던 경우에서(82.1% vs 69.6%) 많이 발생하였다. 결 론: 결핵흉막염의 항결핵제 치료 중에 발생하는 역설적 반응은 드물지 않았으며 환자의 연령과 흉수의 백혈구 중 림프구의 백분율이 역설적 반응의 발생빈도와 관련이 있었다.

Keywords

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