卡马西平致Stevens-Johnson综合征与用药安全性

Carbamazepine-Induced Stevens-Johnson Syndrome and Safety

探讨1例卡马西平致Stevens-Johnson综合征的严重不良反应,为临床安全用药提供参考。1例55 a女性患者因牙痛及上唇软组织疼痛服用卡马西平0.2 g,2次/天。11 d后,患者全身出现红斑、丘疹,口腔、眼睛、外生殖器皮肤、黏膜糜烂,伴发热。停用卡马西平,予以西替利嗪、葡萄糖酸钙、甲泼尼龙等治疗,患者皮疹逐渐好转,3周后糜烂面结痂愈合。通过此病例,从机制、代谢、早期症状探讨卡马西平的用药安全性,警惕临床上此药导致Stevens-Johnson综合征的潜在危险性。CYP3A4的变异、携带HLA-B*1502基因型、人体代谢率低下、起始剂量较大、潜伏期长等因素影响卡马西平的用药安全,临床上应与患者做好沟通工作,在用药过程中如出现发热、皮疹等不适症状,应及早治疗。

To investigate a patient with carbamazepine-induced Stevens-Johnson syndrome,provide a reference for clinical safety of drugs. A 55-year-old woman took carbamazepine 0.2 g twice a day for toothache and upper lip soft tissue pain. Eleven days later,she developed red spot and papula nearly all over. Skin and mucosal erosion appeared on her mouth,eyes and vulva,accompanied by fever.Carbamazepine was stopped immediately. She was treated with cetirizine,calcium gluconate,methylprednisolone and so on. Her rashes gradually improved. Three weeks later,the erosion was turned into scar. From this case,the safety of carbamazepine was evaluated by its mechanism,metabolic and the early symptoms of Stevens-Johnson syndrome. We should pay attention to the potential danger of Stevens-Johnson syndrome caused by carbamazepine. There are many factors that can influence carbamazepine＇ s safety including the variability of CYP3A4,HLA-B＊ 1502 genotype carriers,low metabolic rate,a larger starting dose,etc. Doctors should enhance their communication with patients. If you find your patients have a fever or a rash and so on,you should give a treatment as soon as possible.