$\require{mediawiki-texvc}$
  • 검색어에 아래의 연산자를 사용하시면 더 정확한 검색결과를 얻을 수 있습니다.
  • 검색연산자
검색연산자 기능 검색시 예
() 우선순위가 가장 높은 연산자 예1) (나노 (기계 | machine))
공백 두 개의 검색어(식)을 모두 포함하고 있는 문서 검색 예1) (나노 기계)
예2) 나노 장영실
| 두 개의 검색어(식) 중 하나 이상 포함하고 있는 문서 검색 예1) (줄기세포 | 면역)
예2) 줄기세포 | 장영실
! NOT 이후에 있는 검색어가 포함된 문서는 제외 예1) (황금 !백금)
예2) !image
* 검색어의 *란에 0개 이상의 임의의 문자가 포함된 문서 검색 예) semi*
"" 따옴표 내의 구문과 완전히 일치하는 문서만 검색 예) "Transform and Quantization"
쳇봇 이모티콘
안녕하세요!
ScienceON 챗봇입니다.
궁금한 것은 저에게 물어봐주세요.

논문 상세정보

초록

연구 배경 : IFN-${\gamma}$는 결핵에 대한 방어기전에서 가장 중요한 역할을 하는 사이토카인이다. 최근 일부 다제내성결핵 환자에서 치료제로써 사용되어 왔으나 아직 그 효과는 확실히 알려져 있지 않다. 본 연구는 난치성 다제내성폐결핵 환자에서 피하주사 IFN-${\gamma}$의 효과를 알아보기 위하여 시행되었다. 방 법 : 6명의 다제내성폐결핵 환자에서 기존의 항결핵치료를 유지하면서 200만 IU의 IFN-${\gamma}$를 1주 3회, 피하주사하였다. 16주간 치료후 반응이 없으면 치료를 중단하였고, 반응이 있거나 판정이 모호한 경우에는 12주간 더 연장하여 사용하였다. 치료중 4주간격으로 객담 항산균 도말 및 배양검사, 임상상, 및 단순흉부촬영을 시행하였다. 결 과 : 대상환자는 남녀비가 4:2이었고 평균 연령은 37세(15-61)이었다. 5명에서 과거 폐결핵의 기왕력이 있었다. 약제감수성검사상 isoniazid와 rifampicin을 포함하여 평균 6.8(${\pm}1.2$)개의 항결핵약제에 내성을 보였고, IFN-${\gamma}$ 치료 전 10.8개(${\pm}1.3$) 약제를 투여하였다. IFN-${\gamma}$ 치료 28주 후 총 2명에서 균음전되었다. 그러나 IFN-${\gamma}$ 종료후 다시 균배양 양성으로 재발되었다. 모든 환자에서 IFN-${\gamma}$ 피하주사를 종료할 만한 중증 부작용은 관찰되지 않았다. 결 론 : 일부 난치성 다제내성폐결핵 환자에서 피하주사 IFN-${\gamma}$ 병합치료는 균음전 및 치료성공을 유도하였다. 추후 최적 용량, 치료기간, 투여경로, 및 반응의 예측인자를 찾기 위한 연구가 진행되어야 할 것으로 사료된다.

Abstract

Background : Interferon-gamma (IFN-${\gamma}$) is a critical cytokine in the defense against a Mycobacterium tuberculosis infection. Even though IFN-${\gamma}$ has occasionally been used in the treatment of refractory multidrug-resistant tuberculosis (MDR-TB) with some promising results, there is still some controversy regarding the therapeutic efficacy of IFN-${\gamma}$. This study was performed to examine the effect of subcutaneous IFN-${\gamma}$ in the treatment of MDR-TB patients. Methods : Six patients with refractory MDR-TB were enrolled in this study. Two million IU of IFN-${\gamma}$ was administered subcutaneously three times a week with the concomitant administration of antituberculous drugs for at least for 28 weeks. During the IFN-${\gamma}$ therapy, the sputum smear and culture, radiological and clinical evaluations were performed every 4 weeks throughout the study period. Results : The mean age of the 6 patients was 37 years (ranges, 15-61 years). The drug susceptibility test to standard antituberculous drugs revealed resistance to an average of 6.8 (${\pm}1.2$) agents including isoniazid and rifampicin. An average of 10.8 (${\pm}1.3$) antituberculous drugs were prescribed before IFN-${\gamma}$ therapy. The culture became negative in 2 patients (33%) after initiating IFN-${\gamma}$ therapy; one at 8 weeks, and the other at 24 weeks. Finally, after stopping the IFN-${\gamma}$ therapy after 28 weeks, the culture became positive again in the two patients who were culture-negative. The other 4 patients who failed in the culture conversion are still on antituberculous treatment except for one who died of tuberculosis. Conclusion : Even though 28 weeks of subcutaneous IFN-${\gamma}$ therapy in combination with antituberculous drugs was successful in inducing the culture-negative conversion in some patients with refractory MDR-TB, the culture became positive again after stopping the IFN-${\gamma}$ therapy. This suggests that subcutaneous IFN-${\gamma}$ therapy may have suppressive effect on tuberculosis only during the IFN-${\gamma}$ therapy period in some patients. Further studies will be needed to determine the optimum dose, the administration route, the duration of therapy, and the predicting factors of the response to adjuvant IFN-${\gamma}$ therapy.

참고문헌 (25)

  1. Raviglione MC, Snider DE Jr, Kochi A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic. JAMA 1995;273:220-6 
  2. Nathan CF, Kaplan G, Levis WR, Nusrat A, Witmer MD, Sherwin SA, et al. Local and systemic effects of intradermal recombinant interferon-gamma in patients with lepromatous leprosy. N Engl J Med 1986;315:6-15 
  3. Antoniou KM, Ferdoutsis E, Bouros D. Interferons and their application in the diseases of the lung. Chest 2003;123:209-16 
  4. Cooper AM, Dalton DK, Stewart TA, Griffin JP, Russell DG, Orme IM. Disseminated tuberculosis in interferon gamma gene-disrupted mice. J Exp Med 1993;178:2243-7 
  5. Holland SM, Eisenstein EM, Kuhns DB, Turner ML, Fleisher TA, Strober W, et al. Treatment of refractory disseminated nontuberculous mycobacterial infection with interferon gamma. A preliminary report. N Engl J Med 1994;330:1348-55 
  6. Squires KE, Brown ST, Armstrong D, Murphy WF, Murray HW. Interferon-gamma treatment for Mycobacterium avium-intracellulare complex bacillemia in patients with AIDS. J Infect Dis 1992;166:686-7 
  7. Sampaio EP, Moreira AL, Sarno EN, Malta AM, Kaplan G. Prolonged treatment with recombinant interferon gamma induces erythema nodosum leprosum in lepromatous leprosy patients. J Exp Med 1992;175:1729-37 
  8. Johnson BJ, Ress SR, Willcox P, Pati BP, Lorgat F, Stead P, et al. Clinical and immune responses of tuberculosis patients treated with low-dose IL-2 andmultidrug therapy. Cytokines Mol Ther 1995;1:185-96 
  9. Koh WJ, Kwon OJ, Suh GY, Chung MP, Kim H, Lee NY, et al. Six-month therapy with aerosolized interferon-$\gamma$ for refractory multidrug-resistant pulmonary tuberculosis. J Korean Med Sci 2004;19:167-71 
  10. Flynn JL, Chan J, Triebold KJ, Dalton DK, Stewart TA, Bloom BR. An essential role for interferon gamma in resistance to Mycobacterium tuberculosis infection. J Exp Med 1993;178:2249-54 
  11. Raad I, Hachem R, Leeds N, Sawaya R, Salem Z, Atweh S. Use of adjunctive treatment with interferon-gamma in an immunocompromised patient whohad refractory multidrug-resistant tuberculosis of the brain. Clin Infect Dis 1996;22:572-4 
  12. Bloom BR, Murray CJ. Tuberculosis: commentary on a reemergent killer. Science 1992;257:1055-64 
  13. Palmero D, Eiguchi K, Rendo P, Castro Zorrilla L, Abbate E, Gonzalez Montaner LJ. Phase II trial of recombinant interferon-alpha2b in patients with advanced intractable multidrug-resistant pulmonary tuberculosis: long-term follow-up. Int J Tuberc Lung Dis 1999;3:214-8 
  14. Squires KE, Murphy WF, Madoff LC, Murray HW. Interferon-gamma and Mycobacterium avium-intracellulare infection. J Infect Dis 1989;159:599-600 
  15. Kaplan G, Mathur NK, Job CK, Nath I, Cohn ZA. Effect of multiple interferon gamma injections on the disposal of Mycobacterium leprae. Proc Natl Acad SciUSA 1989;86:8073-7 
  16. Jouanguy E, Altare F, Lamhamedi S, Revy P, Emile JF, Newport M, et al. Interferon-gamma-receptor deficiency in an infant with fatal bacille Calmette-Guerin infection. N Engl J Med 1996;335:1956-61 
  17. Condos R, Rom WN, Schluger NW. Treatment of multidrug-resistant pulmonary tuberculosis with interferon-gamma via aerosol. Lancet 1997;349:1513-5 
  18. Kochi A. The global tuberculosis situation and the new control strategy of the World Health Organization. Tubercle 1991;72:1-6 
  19. Gallin JI, Farber JM, Holland SM, Nutman TB. Interferon-gamma in the management of infectious diseases. Ann Intern Med 1995;123:216-24 
  20. Newport MJ, Huxley CM, Huston S, Hawrylowicz CM, Oostra BA, Williamson R, et al. A mutation in the interferon-gamma-receptor gene and susceptibility to mycobacterial infection. N Engl J Med 1996;335:1941-9 
  21. Lopez􀁔Maderuelo D, Arnalich F, Serantes R, Gonzalez A, Codoceo R, Madero R, et al. Interferon-gamma and interleukin-10 gene polymorphisms in pulmonary tuberculosis. Am J Respir Crit Care Med 2003;167:970-5 
  22. Kemper CA, Bermudez LE, Deresinski SC. Immuno-modulatory treatment of Mycobacterium avium complex bacteremia in patients with AIDS by use ofrecombinant granulocyte-macrophage colony-stimulating factor. J Infect Dis 1998;177:914-20 
  23. Kaplan G, Britton WJ, Hancock GE, Theuvenet WJ, Smith KA, Job CK, et al. The systemic influence of recombinant interleukin 2 on the manifestations of lepromatous leprosy. J Exp Med 1991;173:993-1006 
  24. Giosue S, Casarini M, Alemanno L, Galluccio G, Mattia P, Pedicelli G, et al. Effects of aerosolized interferon-alpha in patients with pulmonary tuberculosis. Am J Respir Crit Care Med 1998;158:1156-62 
  25. Holland SM. Cytokine therapy of mycobacterial infections. Adv Intern Med 2000;45:431-52 

이 논문을 인용한 문헌 (0)

  1. 이 논문을 인용한 문헌 없음

DOI 인용 스타일