白血球遊走試験による薬剤過敏性肝障害の検討

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The identification of allergenic drugs was performed in 79 patients suspected of suffering from drug-induced hepatic injury using the leucocyte migration test (LMT). Moreover, the LMT was performed on the adminis-tered drugs in 35 patients who had been receiving drugs but had not yet manifested any allergic symptoms (patients without hypersensitivity to drugs). If either leucocyte migration activating factor (LMAF) or leucocyte migration inhibitory factor (LMIF) was detected in the LMT either with or without the patient's serum, then the test results were regarded as positive. The proportion of LMT positives was 67.1% in 79 patients suspected of suffering drug-induced hepatic injury and 8. 6% in 35 patients without any such hypersensitivity to the drugs, and therefore the positive rate was significantly higher in the patients suspected of suffering drug-induced hepatic injury than in the patients without hypersensitivity to the drugs (p<0.0001, X^2-test). The proportion of LMT positives was 45. 6% for tests with the patient's serum and 46. 8% for tests without the patient's serum, and there was no substantial difference in the LMT-positive rate between both tests. In addition, no substantial difference was observed among the four clinical types of hepatic injuries. In addition, LMAF was detected in 34. 2% and LMIF in 38.0%, and no substantial difference was seen in the rate of detection between both factors. However, concomitant symptoms were observed in 34 cases (43.0%). The proportion of LMT positives was 82.4% in the cases with concomitant symptoms and 55.6% in those without concomitant symptoms. Accordingly, the proportion of LMT positives were significantly higher in the cases with concomitant symptoms than in those without concomitant symptoms (p<0.05, X^2-test). LMT-positive drugs were detected in 57 cases, in which 38. 6% were β-lactam antibiotics and 17. 5% were non-steroidal antiinflammatory drugs. LMAF was more frequently detected in pa-tients with β-lactam antibiotic-induced hepatic injury (p<0.01, X^2-test), while LMIF was detected more frequently in the patients with non-steroidal antiinflammatory drug-induced hepatic injury (p<0.01, X^2-test). The latent period from the start of drug administration to the onset of hepatic injury was 6. 3 days in the patients with β-lactam antibiotic-induced hepatic injury but 33. 7 days in those with hepatic injury induced by central nervous system drugs, except for non-steroidal antiinflammatory drugs (<p0.05, t-test). Our findings indicate that the LMT is a valuable method for identifying allergenic drugs in drug-induced hypersensitivity hepatic injury, while cell-mediated immunity was shown to be closely involved In the pathogenesis of hepatic injury with concomitant symptoms and the patient's serum may thus play little role in the pathogenesis of drug-induced hepatic injury. Furthermore, the pathogenic mechanism ofβ-lactam antibiotic-induced hepatic injury was also found to possibly be different from that of non-steroidal antiinflammatory drug-induced hepatic injury. The latent period from the start of drug administration up until the onset of β-lactam antibiotic-induced hepatic injury may be shorter than that of hepatic injury induced by central nervous system drugs, except for non-steroidal antiinflammatory drugs.
日本医療薬学会の論文
2001-02-10

白血球遊走試験による薬剤過敏性肝障害の検討

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