中华皮肤科杂志 ›› 2020, Vol. 53 ›› Issue (9): 680-684.doi: 10.35541/cjd.20200296

• 论著 • 上一篇    下一篇

内蒙古汉族Stevens-Johnson综合征/中毒性表皮坏死松解症患者致敏药物及HLA基因筛查

李欣,韩建文   

  1. 内蒙古医科大学附属医院皮肤科，呼和浩特  010010
  • 收稿日期:2020-03-27 修回日期:2020-07-09 发布日期:2020-08-31
  • 通讯作者: 韩建文 E-mail:hanjianwen1981@hotmail.com
  • 基金资助:
    国家自然科学基金（81660513）；皮肤病学教育部重点实验室开放基金（AY2017?1?009）；内蒙古医科大学青年创新基金（YKD2016QNCX031）

Analysis of culprit drugs and screening for human leukocyte antigen genes in patients of Han nationality with Stevens-Johnson syndrome/toxic epidermal necrolysis in Inner Mongolia

Li Xin, Han Jianwen   

  1. Department of Dermatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010010, China
  • Received:2020-03-27 Revised:2020-07-09 Published:2020-08-31
  • Contact: Han Jianwen E-mail:hanjianwen1981@hotmail.com
  • Supported by:
    National Natural Science Foundation of China （81660513）; Open Research Fund of Ministry of Education Key Laboratory of Dermatology （AY2017?1?009）; Youth Innovation Fund Project of Inner Mongolia Medical University （YKD2016QNCX031）

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摘要： 【摘要】 目的 总结内蒙古汉族Stevens-Johnson综合征/中毒性表皮坏死松解症（SJS/TEN）患者致敏药物及筛查易感基因。方法 内蒙古医科大学附属医院皮肤科2015—2019年确诊的68例汉族SJS/TEN患者，抽取外周血提取DNA，采用PCR筛查HLA-B*5801、HLA-B*1502、HLA-A*3101等位基因。收集患者的临床资料，参照基因分型，分析致敏药物。结果 68例SJS/TEN患者，男36例，女32例，年龄46.06 ± 19.97（3 ~ 84）岁。检出HLA-B*5801阳性5例，4例为别嘌醇致敏；HLA-B*1502阳性14例，5例为卡马西平、4例为拉莫三嗪致敏，5例致敏/可疑致敏药物为抗菌药物、解热镇痛药等；HLA-A*3101阳性1例，可疑致敏药物为中药活血针剂，成分不清。结论 HLA-B*5801对别嘌醇、HLA-B*1502对卡马西平和拉莫三嗪的预测性良好，建议用药前筛查，而HLA-A*3101在本地区人群阳性率不高。

关键词: Stevens-Johnson综合征, 表皮坏死松解症, 中毒性, HLA-A抗原, HLA-B抗原, 基因型, 卡马西平, 别嘌呤醇

Abstract: 【Abstract】 Objective To analyze culprit drugs and screen susceptible genes in patients of Han nationality with Stevens-Johnson syndrome （SJS）/toxic epidermal necrolysis （TEN） in Inner Mongolia. Methods A total of 68 patients of Han nationality with confirmed SJS/TEN were collected from Department of Dermatology, the Affiliated Hospital of Inner Mongolia Medical University between 2015 and 2019. DNA was extracted from peripheral blood samples, and PCR was performed to screen HLA-B*5801, HLA-B*1502 and HLA-A*3101 alleles. Clinical data were collected from the patients, and culprit drugs were analyzed according to the genotypes. Results Among the 68 patients with SJS/TEN, there were 36 males and 32 females, aged 46.06 ± 19.97 （range, 3 - 84） years. Five cases were positive for HLA-B*5801 allele, of which 4 were induced by allopurinol; 14 cases were positive for HLA-B*1502 allele, of which 5 were induced by carbamazepine, 4 were induced by lamotrigine, and 5 were induced or likely induced by antibiotics and antipyretic analgesics; only 1 case was positive for HLA-A*3101 allele, and the suspected culprit drug was a traditional Chinese medicine injection for promoting blood circulation with unclear ingredients. Conclusions HLA-B*5801 has a good predictive effect on allopurinol-induced drug eruptions, and HLA-B*1502 on carbamazepine- and lamotrigine-induced drug eruptions. It is recommended to screen susceptible genes before medication. However, the positive rate of HLA-A*3101 was not very high in the population in Inner Mongolia.

Key words: Stevens-Johnson syndrome, Epidermal necrolysis, toxic, HLA-A antigens, HLA-B antigens, Genotype, Carbamazepine, Allopurinol