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頁籤選單縮合
題名 | Ethambutol視神經毒性之臨床研究=Clinical Study on Ethambutol-Induced Optic Nerve Toxicity |
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作者 | 周介仁; 翁林仲; 施永豐; 侯平康; Jou, Jieh-ren; Woung, Lin-chung; Shih, Yung-feng; Hou, Ping-kang; |
期刊 | 慈濟醫學 |
出版日期 | 19970600 |
卷期 | 9:2 1997.06[民86.06] |
頁次 | 頁107-113 |
分類號 | 418.2219 |
語文 | chi |
關鍵詞 | 視神經病變; 視神經盤蒼白; 色覺功能檢查; Ethambutol; Optic neuropathy; Optic disc pallor; Color vision; |
中文摘要 | Ethambutol 是被公認最具臨床療效的抗結核菌藥物之一。然而它對視神經具毒性 作用卻是不爭的事實, 也是臨床醫師使用此藥物時最擔心的副作用。 一般傳統觀念認為 (1)ethambutol 引起的視神經病變和用藥劑量、用藥療程期間有相關性。若劑量是每天每公 斤 15mg,則發生率小於 1%; 使用劑量若為 25mg,則發生率在 5% 左右。 (2)ethambutol 視神經病變應該屬於可逆性變化;也就是停用此藥以後,則視神經功能可以回復正常。 (3) 色覺功能檢查能夠早期檢查出視神經毒性之發生。我們收集了 31 位使用 ethambutol 治療 結核性疾病後視覺功能受損且追蹤至少 6 個月的病例; 以回顧性研究方式,發現了幾個值 得注意的結果 (1) 縱使使用安全劑量 (少於 15mg/kg/day),對某些病患可能也會有視神經 受損之虞 (2) 病人出現視力減退之症狀後,雖然馬上停藥, 視神經功能依然長期受損,呈 現不可逆變化 (3) 色覺功能檢查顯然並非最早能偵測視神經毒性之方法, 尋找另一種更靈 敏的方法如對比敏感度檢查,使受損視神經有能力回復正常功能是非常重要的課題。 |
英文摘要 | Ethambutol is a very effective anti-tuberculosis agent, however, it is also a neurotoxin whose use can cause optic nerve damgae. Traditionally, ethambutol-induced ocular toxicity has been associated with high dosages and long durations of treatment. The incidence of ocular toxicity occurred in less than 1% of patients receiving a dosage of 15 mg/kg/day, and in 5% of patients receiving a dosage of 25 mg/kg/day. Once abnormal visual function was detected by routine color vision test and the treatment stopped, the optic nerve toxicity appeared to be reversible. However, the results of clinical study, suggesting that this toxicity may in fact cause permanent damage. We found that even under recommended safe dosages, serious visual function impairment may occur. In addition, immediate discontinuation of ethambutol did not guarantee the revesibility of toxic damage. Furthermore, regular color vision test did not prevent irreversible, permanent blindness. Re-evaluation of the efficacy of ethambutol treatment together with development of more senstive screening tests are imperative. |
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