重症药疹64例临床分析

A retrospectiveStudy on 64 Cases of Severe Drug Eruption

目的分析重症药疹的主要致敏药物及其临床特点,探讨致敏药物、重症药疹和机体三者之间的关系。方法回顾性分析我科2007年1月-2015年8月收治的64例重症药疹患者的临床资料。结果 64例重症药疹患者中,重症多形红斑型44例(68.75%),中毒性表皮坏死松解型13例(20.31%),剥脱性皮炎型7例(10.94%),其中符合药物超敏反应综合症者3例。主要致敏药物分别是别嘌呤醇29例(45.31%)、抗癫痫药13例(20.31%)、抗生素8例(12.5%)。64例患者中50例有各系统的原发疾病,均加重了其原发病的损害,且易诱发肝肾功能损害、继发感染等,共死亡3例,均为重症多形红斑型(死亡率为4.69%),其中1例符合药物超敏反应综合症。结论重视临床用药安全性,掌握重症药疹发病规律和妥善治疗是使稳定病情和降低死亡率的关键,致敏药物和机体间的关系有待进一步探究。

Objective To study the predominate causative drugs and the clinical feature of severe drug eruption, and to explore the relationship among the causative drugs, disease and the body. Methods Sixty-four patients diagnosed with severe drug eruption at the Department of Dermatology of Guangdong General Hospital between January 1, 2007 to August 31, 2015 were retrospectively studied. Results Among 64 cases there were 44 cases （68.75%） of Stevens-Johnson Syndrome （SJS）, 13 cases （20. 31% ） of toxic epidermal necrolysis （TEN） and 7 cases （ 10. 94% ） of exfoliative dermatitis （ ED）, and 3 of them also met the diagnostic criteria of Drug-induced Hypersensitivity Syndrome （DHS）. Twenty-nine cases （45.31% ） were induced by allopurinol, 13 cases （20. 31% ） by antiepileptics and 8 cases （12. 50% ） by antibiotics. Fifty patients had underlying diseases and their conditions were in most cases aggravated, which then resulted in greater risk of complications like infection and hepar and renal functional lesion by suffering severe drug eruption. Three patients with SJS died （mortality rate 4. 69% ）, of whom 1 could be diagnosed with DHS. Conclusion To ensure clinical medication safety, to study the rule of Severe drug eruption and to treat appropriatelyare keys to stabilize the conditions and reduce mortality, while the relationship among the causative drugs, disease and the body requires further inquiry.