卡马西平重症药疹危险因素的临床分析

Clinical analysis of risk factors for severe drug eruption induced by carbamazepine

目的:探讨临床卡马西平重症药疹的危险因素,以减少药疹的发生。方法:收集1997年至2007年服用卡马西平出现药疹的住院患者55例的资料,其中非重症药疹28例,重症药疹27例。统计分析药疹与患者年龄、性别、药物过敏史、癫痫病、药物初始剂量、药疹潜伏期的关系,并对2组患者出现的其他不良反应进行比较。结果:药疹的严重程度与年龄、性别、药物过敏史、癫痫病无关(P>0.05),与卡马西平的起始剂量和药疹潜伏期有关。而重症药疹组和非重症药疹组的卡马西平起始剂量及药疹潜伏期有差异,卡马西平起始剂量分别为(155.74±81.130)mg/d和(124.11±44.867)mg/d(P<0.05),药疹潜伏期分别为(11.81±7.45)d和(6.14±5.30)d(P<0.01)。重症药疹的肝损害较非重症者显著增多(P<0.01),且早期均有发热表现,病情也较重。结论:卡马西平的起始剂量大及药疹潜伏期长可能增加药疹的严重程度。

Objective： To analyse risk factors for severe drug eruption induced by carbamazepine in clinical practice in order to decrease its development. Methods： The clinical data of 55 in-patients with carbamazepine-induced drug eruption were collected from 1997 to 2007. Of the 55 patients, 28 were non-severe eruption and 27 were severe eruption. The relationship between the severe eruption and the age, sex, allergic history, epilepsy, initial dosage of carbamazepine, and latent of eruption was analyzed. Other adverse reactions were compared between the two groups. Results ： The relationship between the severity of drug eruption and the age, sex, allergic history, and epilepsy was not found （ P 〉 0.05 ）. It was linked to initial dose of carbamazepine and longer latent period of eruption. And there were differences in the initial dosage of carbamazepine and the latent period of eruption between the severe eruption group and the non-severe eruption group. The initial dosage of carbamazepine was （155.74± 81. 130） mg/d and （124.11 ±44.867） mg/d（ P 〈 0. 05 ） , respectively. The latent period of eruption was （ 11.81 ±7.45 ） days and （6.14±5.30） days （ P 〈 0.01 ）. The severity of liver damage in patients with severe eruption is greater than that in patient with non-severe eruption （ P 〈 0.01 ）. The condition of patients with a fever occurring in the early stage was severe. Conclusion： The high initial dose of carbamazepine and long latent period of eruption may increase the drug eruption intensity.