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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >The Elderly Respond to Antimony Therapy for Cutaneous Leishmaniasis Similarly to Young Patients but Have Severe Adverse Reactions
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The Elderly Respond to Antimony Therapy for Cutaneous Leishmaniasis Similarly to Young Patients but Have Severe Adverse Reactions

机译：老年人应对皮肤利什曼病的锑疗法与年轻患者类似但具有严重的不良反应

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摘要

There is evidence that elderly patients with cutaneous leishmaniasis (CL) have more mucosal and disseminated diseases than young patients and their cells produce less antigen-induced interferon (IFN)-gamma. Herein, we compared the roles of interleukin (IL)-10 and IL-15 as modulators of antigen-inducedimmune responses and the incidence of adverse reaction and response to therapy in young versus elderly patients with CL. Study participants included 35 senior (60-85 years) and 35 young (18-40 years) patients who had a diagnosis of CL documented by typical cutaneous lesions containing Leishmania braziliensis DNA. Elderly patients had less lymph node enlargement. Antigen-induced blood cell cytokine responses were studied in the absence or presence of IL-10 antibody or exogenously added recombinant IL-15. The ratio of IFN-gamma/IL-10 was lower in elderly patients, and IFN-gamma production was enhanced by either neutralization of IL-10 or exogenous recombinant IL-15 in blood cells from elderly but not young patients. Patients were treated three times weekly with antimony at 20 mg/kg/day for 20 doses. Although there was no difference in response to therapy between the two groups, two young patients needed rescue therapy with amphotericin B. Ventricular arrhythmias and ventricular overload were more frequent in elderly patients. Weconclude that elderly patients have alterations in the immune response that may influence clinical manifestations, but we did not find that they had a higher failure rate than young subjects to antimony therapy. However, because of the high rate of electrocardiographic abnormalities during therapy, antimony should not be used in elderly patients with CL.
机译：有证据表明，患有皮肤利什曼病（CL）的老年患者比年轻患者有更多的粘膜和播散性疾病，他们的细胞产生的抗原诱导干扰素（IFN）-γ更少。在此我们比较了白细胞介素（IL）-10和白细胞介素-15作为抗原诱导的免疫应答调节剂的作用，以及年轻和老年CL患者的不良反应和治疗反应的发生率。研究参与者包括35名老年（60-85岁）和35名年轻（18-40岁）患者，他们被诊断为CL，并记录在含有巴西利什曼原虫的典型皮肤病变中脱氧核糖核酸老年患者淋巴结肿大较少。在不存在或存在IL-10抗体或外源性添加重组IL-15的情况下，研究抗原诱导的血细胞细胞因子反应。老年患者的IFN-γ/IL-10比值较低，老年患者（而非年轻患者）血细胞中的IL-10中和或外源性重组IL-15可增强IFN-γ的产生。患者每周接受三次锑治疗，剂量为20 mg/kg/天，共20剂。虽然两组患者对治疗的反应没有差异，但有两名年轻患者需要两性霉素B的抢救治疗。老年患者室性心律失常和室性超负荷的发生率更高。我们得出结论，老年患者的免疫反应发生改变，可能会影响临床表现，但我们没有发现他们接受锑治疗的失败率高于年轻受试者。然而，由于治疗期间心电图异常的发生率很高，锑不应用于老年CL患者。

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