中华皮肤科杂志 ›› 2016, Vol. 49 ›› Issue (7): 460-464.

• 论著 • 上一篇    下一篇

药物斑贴试验对儿童迟发型药物超敏反应诊断的探讨

孙晨,陈静思,谭琦,任发亮,杨欢,向娟,罗晓燕,王华   

  1. 重庆医科大学附属儿童医院
  • 收稿日期:2015-11-20 修回日期:2016-02-21 发布日期:2016-06-30
  • 通讯作者: 王华 E-mail:huawang63@hotmail.com
  • 基金资助:

    重庆市卫生局医学科研计划项目重点项目

Performance of drug patch tests in the diagnosis of delayed drug hypersensitivity reactions in children

Chen SUN1, 1,Tan Qi2,Fa-Liang REN3,Yang Huan向娟 Juan Xiang罗晓燕 LUO Xiao-Yanhua Wang   

  • Received:2015-11-20 Revised:2016-02-21 Published:2016-06-30
  • Contact: hua Wang E-mail:huawang63@hotmail.com

摘要:

目的 探讨药物斑贴试验在诊断儿童迟发型药物超敏反应(DDHR)中的安全性和价值。方法 54例DDHR患儿(病例组)行可疑致敏药物斑贴试验,其中10例轻型DDHR患儿同时行长时程连续口服药物激发试验,以验证斑贴试验的准确性。20例健康儿童(对照组)行常见药物的斑贴试验,以验证其特异度。结果 病例组54例患儿中16例斑贴试验阳性,阳性率29.63%;对照组20例斑贴试验均阴性,斑贴试验的特异度为100.00%。40例轻型DDHR患儿中9例斑贴试验阳性,阳性率为22.50%;14例重型DDHR患儿中7例阳性。斑贴试验阳性的致敏药物共19种,包括抗生素、解热镇痛药及其与抗组胺药、减充血剂、镇咳祛痰药和(或)中药构成的复方抗感冒制剂(以下简称感冒药)、抗癫痫类药。40例可疑抗生素致敏者中8例阳性(20.00%);35例可疑解热镇痛药及感冒药致敏者中4例阳性(11.43%);5例可疑抗癫痫类药物致敏者中4例阳性;18例可疑中药致敏者均阴性。10例轻型DDHR患儿继斑贴试验后行口服药物激发试验,7例斑贴试验结果与口服药物激发试验结果一致,斑贴试验结果假阴性1例,口服药物激发试验结果假阴性2例。1例患儿斑贴试验引起皮疹复发,诱发皮疹的不良反应发生率1.85%(1/54)。结论 药物斑贴试验对诊断儿童DDHR安全、可行。临床试验注册 中国临床试验注册中心,ChiCTR?DPD?14005254。

Abstract:

Sun Chen, Chen Jingsi, Tan Qi, Ren Faliang, Yang Huan, Xiang Juan, Luo Xiaoyan, Wang Hua Department of Dermatology, Children′s Hospital of Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Key Laboratory of Pediatrics in Chongqing, Chongqing 400014, China Corresponding author: Wang Hua, Email: huawang63@hotmail.com 【Abstract】 Objective To investigate the safety and clinical value of drug patch tests in diagnosing delayed drug hypersensitivity reactions (DDHR) in children. Methods Fifty?four pediatric patients with DDHR (experimental group) underwent patch tests with suspected culprit drugs, and 10 patients with mild DDHR proceeded to undergo drug provocation tests for the evaluation of the diagnostic accuracy of patch tests. Twenty healthy children (control group) underwent patch tests with common culprit drugs for the evaluation of the specificity of patch tests. Results Drug patch tests were positive in 16 out of 54 patients in the experimental group with a positive rate of 29.63%, but in none of the 20 healthy controls with a specificity of 100.00%. The positive rate of drug patch tests was 9/40 (22.50%) in patients with mild DDHR, and 7/14 in patients with severe DDHR. Patch tests were positive to 19 culprit drugs, including antibiotics, antipyretic analgesics, anti?common cold compound preparations (containing antipyretic analgesics, antihistamines, decongestants, cough?relieving and phlegm?expelling drugs, and [or] traditional Chinese medicines), as well as antiepileptics. Moreover, drug patch tests were positive in 8 (20.00%) out of 40 patients with suspected hypersensitivity to antibiotics, 4 (11.43%) out of 35 patients with suspected hypersensitivity to antipyretic analgesics and anti?common cold compound preparations, and in 4 out of 5 patients with suspected hypersensitivity to antiepileptics, but in none of 18 patients with suspected hypersensitivity to traditional Chinese medicines. Among 10 patients who underwent drug provocation tests, 7 showed consistent results between provocation tests and patch tests, 1 showed false?negative patch test reactions, and 2 showed false?negative drug provocation test reactions. Only one patient showed relapse of rashes during drug patch tests, with the incidence of adverse reactions being 1.85% (1/54). Conclusions Drug patch tests are a safe and practicable diagnostic tool for the diagnosis of DDHR in children. Trial registration Chinese Clinical Trial Registration Center, ChiCTR?DPD?14005254.

中图分类号: 

  • R758.25

引用本文

孙晨 陈静思 谭琦 任发亮 杨欢 向娟 罗晓燕 王华. 药物斑贴试验对儿童迟发型药物超敏反应诊断的探讨[J]. 中华皮肤科杂志, 2016,49(7):460-464. doi:

Chen SUN Tan Qi Fa-Liang REN Yang Huan 向娟 Juan Xiang 罗晓燕 LUO Xiao-Yan hua Wang. Performance of drug patch tests in the diagnosis of delayed drug hypersensitivity reactions in children[J]. Chinese Journal of Dermatology, 2016, 49(7): 460-464.doi: