中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (2): 127-130.doi: 10.35541/cjd.20200420

• 论著 • 上一篇    下一篇

药物超敏反应综合征45例临床特点分析

邓思思    王欢    余南岚    黎松    宋志强   

  1. 陆军军医大学第一附属医院（西南医院）皮肤科，重庆  400038
  • 收稿日期:2020-04-30 修回日期:2020-10-19 发布日期:2021-01-29
  • 通讯作者: 宋志强 E-mail:zhiqiang.song@hotmail.com
  • 基金资助:
    国家自然科学基金（81673059）；西南医院创新团队建设培养计划项目（SWH2018TD-02）

Clinical analysis of 45 cases of drug-induced hypersensitivity syndrome

Deng Sisi, Wang Huan, Yu Nanlan, Li Song, Song Zhiqiang   

  1. Department of Dermatology, The First Affiliated Hospital （Southwest Hospital） of Army Medical University, Chongqing 400038, China
  • Received:2020-04-30 Revised:2020-10-19 Published:2021-01-29
  • Contact: Song Zhiqiang E-mail:zhiqiang.song@hotmail.com
  • Supported by:
    National Natural Science Foundation of China （81673059）; Southwest Hospital Innovative Team Construction Training Project （SWH2018TD-02）

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摘要： 【摘要】 目的 总结药物超敏反应综合征的临床特点，比较欧洲、日本和中国诊断标准的差异。方法 收集陆军军医大学西南医院2009年1月至2019年1月确诊的45例药物超敏反应综合征，均根据Bocquet提出的标准诊断。回顾45例患者的病历资料，总结临床特点，分别采用欧洲标准、日本标准和中国标准重新评判，比较患者在潜伏期、皮疹消退时间、嗜酸性粒细胞数目、肝功能指标等方面的差异。多组间均数比较采用单因素方差分析，两组间均数比较采用t检验。结果 38例患者皮疹表现为发疹型药疹，44例伴肝功能损害，40例伴外周血白细胞升高，38例伴嗜酸性粒细胞增多，21例伴淋巴结肿大，4例伴黏膜损害。常见的致敏药物分别为别嘌醇（10例）、抗结核药（7例）、头孢菌素（7例）、中药（4例）。40例使用糖皮质激素治疗，17例联合糖皮质激素与静脉用丙种球蛋白，最终44例好转，1例死亡。45例患者按欧洲标准，29例为可能诊断和16例为确诊；按日本标准37例可确诊，8例不能确诊；按中国标准17例可确诊，28例不能确诊。按日本标准的可确诊组潜伏期（36.91 ± 21.73） d长于不能确诊组［（20.00 ± 20.82） d，P = 0.04］。结论 药物超敏反应综合征常见致敏药物包括别嘌醇、抗结核药及头孢菌素，且多数伴发肝功能损害，诊断时更推荐欧洲标准。

关键词: 药疹, 反应时间, 别嘌醇, 药物超敏反应综合征, 临床特点

Abstract: 【Abstract】 Objective To analyze clinical characteristics of drug-induced hypersensitivity syndrome （DIHS）, and to compare the European, Japanese and Chinese diagnostic criteria. Methods A total of 45 patients confirmedly diagnosed with DIHS according to the DIHS criteria originally proposed by Bocquet, were collected from the First Affiliated Hospital （Southwest Hospital） of Army Medical University between January 2009 and January 2019. Clinical data on the 45 patients were retrospectively analyzed, clinical characteristics were summarized and re-evaluated according to the European, Japanese and Chinese diagnostic criteria separately, and differences were analyzed in terms of the latency period, time to rash regression, eosinophil count, liver function indices, etc. One-way analysis of variance was used to compare means among multiple groups, and t test to compare means between two groups. Results Of the 45 patients, 38 presented with eruptive drug eruptions, and 44 were accompanied by liver damage, 40 by elevated counts of peripheral white blood cells, 38 by eosinophilia, 21 by lymphadenectasis, and 4 by mucosal damage. Common culprit drugs included allopurinol （10 cases）, anti-tuberculosis drugs （7 cases）, cephalosporins （7 cases）, and Chinese medicine （4 cases）. Forty patients were treated with glucocorticoids, and 17 with glucocorticoids and intravenous gamma globulin. After treatment, 44 patients received improvement and 1 died. According to the European diagnostic criteria, there were 29 patients with suspected DIHS and 16 with confirmed DIHS; according to the Japanese diagnostic criteria, 37 patients could be confirmedly diagnosed with DIHS, but 8 could not be confirmedly diagnosed; according to the Chinese diagnostic criteria, 17 patients could be confirmedly diagnosed, but 28 could not be confirmedly diagnosed. According to the Japanese diagnostic criteria, the latency period was significantly longer in the patients with a confirmed diagnosis （36.91 ± 21.73 d） than in those without （20.00 ± 20.82 d, P = 0.04）. Conclusions Common culprit drugs for DIHS include allopurinol, anti-tuberculosis drugs and cephalosporins. Most patients with DIHS are accompanied by liver damage, and the European diagnostic criteria are preferentially recommended for DIHS.

Key words: Drug eruptions, Reaction time, Allopurinol, Drug induced hypersensitivity syndrome, Clinical characteristics