中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (11): 984-989.doi: 10.35541/cjd.20201110

• 论著 • 上一篇    下一篇

63例重症药疹住院患者发热及肝损伤特征分析

姚翠玲1    王紫涵2    胡景景3    高昱1    丁长玲4   

  1. 1滨州医学院附属医院皮肤科，山东  256603；2烟台山医院皮肤科，山东烟台  264000；3枣庄市皮肤病性病防治院，山东  277100；4滨州医学院附属医院药学部，山东  256603
  • 收稿日期:2020-11-20 修回日期:2021-08-27 发布日期:2021-11-01
  • 通讯作者: 高昱 E-mail:binyigaoyu@126.com
  • 基金资助:
    山东省医药卫生科技发展计划项目（2014WS0488）；山东省药品不良反应监测方法系列研究项目（2017SDADRKY06）；滨州医学院科技计划项目（BY2013KJ12）

Analysis of fever and drug-induced liver injury in 63 patients with severe drug eruptions

Yao Cuiling1, Wang Zihan2, Hu Jingjing3, Gao Yu1, Ding Changling4   

  1. 1Department of Dermatology, Binzhou Medical University Hospital, Binzhou 256603, Shandong, China; 2Department of Dermatology, Yantaishan Hospital, Yantai 264000, Shandong, China; 3Department of Dermatology, Zaozhuang Dermatology and STD Prevention and Treatment Hospital, Zaozhuang 277100, Shangdong, China; 4Department of Pharmacy, Binzhou Medical University Hospital, Binzhou 256603, Shandong, China
  • Received:2020-11-20 Revised:2021-08-27 Published:2021-11-01
  • Contact: Gao Yu E-mail:binyigaoyu@126.com
  • Supported by:
    Shandong Medical and Health Science and Technology Program （2014WS0488）; Shandong Adverse Drug Reaction Monitoring Center Project （2017SDADRKY06）; Science and Technology Plan Project of Binzhou Medical University （BY2013KJ12）

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摘要： 【摘要】 目的 了解重症药疹住院患者的发热及药物性肝损伤（DILI）的特点。方法 回顾分析滨州医学院附属医院2007年6月至2020年6月收住院治疗的63例重症药疹患者的发热及DILI情况。计量资料组间比较采用两独立样本t检验或Kruskal-Wallis H检验；计数资料组间比较采用χ2检验或Fisher精确检验。结果 63例重症药疹患者中，54例出现发热，低、中、高热/超高热者各占约1/3，16例高热/超高热者（16/17）发生于Stevens-Johnson综合征（SJS）、中毒性表皮坏死松解症（TEN）和药物超敏反应综合征（DHS）。45例热型为不规则热；51例热程1 ~ 14 d；不同临床类型药疹患者间热度及热程差异均无统计学意义（P分别为0.303、0.719）；92.59%的患者皮疹早于发热或与发热同时出现。11例患者出现DILI，入院时肝细胞损伤型8例，其中DHS 5例、SJS 2例、TEN 1例；6例伴有发热，低、中、高热均可见，热程（7.33 ± 4.97） d，均为1级肝损伤；出院时复查肝功能5例痊愈，1例好转，1例演变为混合型，1例自动出院未复查肝功能。另3例DILI为胆汁淤积型，均为DHS患者，皆伴有高热或超高热，热程（8.33 ± 3.51） d，其中1例为4级肝损伤（急性肝衰竭）；出院时肝功能均好转。结论 重症药疹热型多样，不规则热多见，热程多 ≤ 2周；皮疹常早于发热或与其同时出现。DILI多合并发热，以肝细胞损伤型更为多见，恢复较快，而胆汁淤积型临床症状重，病程长，好发于DHS。

关键词: 药疹, 药物性肝损伤, 发热, 重症药疹, 胆汁淤积型肝损伤

Abstract: 【Abstract】 Objective To investigate characteristics of fever and drug-induced liver injury （DILI） in inpatients with severe drug eruptions. Methods A retrospective analysis was carried out on clinical data collected from 63 inpatients with severe drug eruptions from June 2007 to June 2020, and their characteristics of fever and DILI were investigated. Two-independent-sample t test or Kruskal-Wallis H test was used for intergroup comparison of measurement data, and intergroup comparison of enumeration data was performed using chi-square test or Fisher′s exact test. Results Among the 63 patients with severe drug eruptions, 54 developed fever; low, moderate and high/ultra-high fever all occurred in about one third of the patients; of 17 patients with high/ultra-high fever, 16 sufferred from Stevens-Johnson syndrome （SJS）, toxic epidermal necrolysis （TEN） or drug hypersensitivity syndrome （DHS）; 45 had irregular fever; fever duration ranged from 1 to 14 days in 51 patients; there were no significant differences in the fever grade or duration among the patients with different clinical types of drug eruptions （P = 0.303, 0.719, respectively）; rashes occurred earlier than or at the same time as fever in 92.59% of the patients. DILI occurred in 11 patients, 8 of whom had hepatocellular injury at admission, including 5 with DHS, 2 with SJS and 1 with TEN; 6 patients were accompanied by low, moderate or high fever, with the fever duration being 7.33 ± 4.97 days, and they all had grade 1 liver injury; liver function retesting at discharge showed complete recovery in 5 patients, improvement in 1, as well as conversion from hepatocellular injury to mixed liver injury in 1, and 1 patient did not undergo the liver function retesting due to against-medical-advice discharge. The other 3 patients had cholestatic liver injury, all of whom were diagnosed with DHS and accompanied by high or ultra-high fever, wtih the fever duration being 8.33 ± 3.51 days, and 1 patient had grade 4 liver injury （acute liver failure）; liver function was improved in all the 3 patients at discharge. Conclusions Patients with severe drug eruptions are prone to be accompanied by various types of fever, irregular fever is more common, fever usually lasts 2 weeks, and rashes often occur earlier than or at the same time as fever. DILI can occur in patients with severe drug eruptions, and is usually accompanied by fever; hepatocellular injury is more common, and prone to be improved rapidly; cholestatic liver injury is characterized by severe clinical symptoms and a long disease course, and most frequently occurs in patients with DHS.

Key words: Drug eruptions, Drug-induced liver injury, Fever, Severe drug eruptions, Cholestatic liver injury