拉莫三嗪致药物超敏反应综合征1例报告及文献分析

One case report and literature analysis of drug-induced hypersensitivity syndrome caused by lamotrigine

目的:探讨药物超敏反应综合征的临床特点、原因及常见致敏药物,为临床合理用药提供参考。方法:报道我院1例拉莫三嗪致药物超敏反应综合征,并通过检索1994-2013年国内医药期刊报道的相关文献进行统计和分析。结果:综合文献报道以及我院拉莫三嗪致药物超敏反应综合征病例共48例。100%的患者有用药史,97.9%患者出现了中高热,97.9%出现肝功能异常,18例谷丙转氨酶(ALT)超过正常上限10倍,22.9%出现肾功能异常,66.7%出现外周血嗜酸粒细胞增多,75%出现浅表淋巴结肿大。治疗主要是应用糖皮质激素,有3例因多器官功能衰竭而死亡。结论:药物超敏反应综合征时有发生,临床应用时应密切关注患者的变化,以减少不良反应发生。

Objective： To investigate the clinical characteristics, causes and common allergenic drugs of drug-induced hypersensitivity syndrome （DIHS） , and to provide references for rational drug use in clinical prac- tice. Methods ： One case of DIHS in our hospital was reported, and relevant literature published in domestic medi- cal journals through 1994 -2013 were retrieved and statistically analyzed. Results： According to reports in the lit- erature and case in our hospital, a total of 48 patients who suffered from drug-induced hypersensitivity syndrome were collected andcomprehensively summarized. 100% patients had medication history, 97.9% had high fever, and 97.9% had abnormal liver function. In 18 patients, alanine aminotransferase （ALT） activity increased 10 times more than the upper limit of normal levels, renal dysfunction occurred in 22.9% of patients, peripheral blood eosinophilia occurred in 66.7% , and superficial lymph nodes appeared in 75%. Main treatment was use of glu- cocorticoids. Three patients died of multiple organ failure. Conclusion： DIHS occurs occasionally; and safety mo- nitoring should be carried out in patients during application of drugs in order to reduce the incidence of ADR.