质子泵抑制剂致亚急性皮肤型红斑狼疮26例分析

An analysis of subacute cutaneous lupus erythematosus due to proton pump inhibitor in 26 cases

目的：总结质子泵抑制剂（PPI）致亚急性皮肤型红斑狼疮（SCLE）的临床特点。方法检索 CNKI、VIP、万方数据知识服务平台和 PubMed 数据库，收集 PPI 致 SCLE 的相关文献，记录患者性别、年龄、既往史、用药情况、用药至发生 SCLE 的时间、临床表现、实验室检查结果、治疗措施及转归，分析 PPI 致 SCLE 的临床特点。结果检索到 PPI 致 SCLE 国外病例报告10篇，患者26例；男性4例（15.4%），女性22例（84.6%）；年龄30~86岁，平均（63±14）岁，＞50岁23例（88.5%）；有自身免疫性疾病史者6例（23.1%）。26例患者均口服用药，共发生 SCLE 27例次，其中兰索拉唑9例次，奥美拉唑8例次，埃索美拉唑和泮托拉唑各5例次。用药至发生 SCLE 的时间为8 d至5年，中位时间3个月。临床表现为躯干、四肢、面部出现多环形红斑或鳞屑样斑丘疹病变，1例伴关节痛。实验室检查结果示抗干燥综合征抗原 A 抗体阳性率为81.8%（18/22），抗核抗体阳性率为76.9%（20/26），抗干燥综合征抗原 B 抗体阳性率为17.6%（3/17），抗组蛋白抗体阳性率为6.3%（1/16），直接免疫荧光试验阳性率为30.0%（6/20）。出现 SCLE 后21例患者停用 PPI，其中14例未进行任何治疗，皮疹消失；1例换用其他 PPI 后死亡；6例接受对症治疗后皮疹消失。出现 SCLE 后继续用药者5例，2例皮疹持续存在，其中1例停药后皮疹消失；3例死亡。结论应用 PPI 后出现SCLE 的患者年龄多＞50岁，多为女性，有自身免疫性疾病史者发生风险较高。出现 SCLE 后立即停药是改善预后的关键。

Objective To summarize the clinical characteristics of subacute cutaneous lupus erythematosus（SCLE）due to proton pump inhibitor（PPI）. Methods The database of China National Knowledge Infrastructure,VIP,Wanfang and PubMed were searched. The reports in literature about SCLE related to PPI were collected. The patients＇ sexuality,age,history of past illness,medications,the time from medication to appearance of SCLE symptoms,clinical characteristics of SCLE,results of laboratory examination,treatment and prognosis. The clinical characteristics of SCLE related to PPI were analyzed. Results A total of 10 cases were reported to have SCLE due to PPI overseas and 26 patients were enrolled in this study. They comprised 4 males（15. 4% ）and 22 females（84. 6% ）with the average age of（63 ± 14）years. Of them,23 cases（88. 5% ）were over 50 year-old,six patients had the history of autoimmune disease. All the patients received PPI orally. Twenty seven case-times of SCLE occurred. Of them,numbers of cases caused by lansoprazole,omeprazole,esomeprazole and pantoprazole were 9,8,5 and 5 case-times, respectively. The time from medication to appearance of SCLE symptoms were from 8 days to 5 years, median time was 3 months. The clinical characteristics of SCLE due to PPI were multiple annular erythema or scale plaque on body,limbs and face. One patient was accompanied by arthralgia. The results of laboratory examination showed the positive rates of anti dry syndrome antigen A antibody（SSA）,antinuclear antibodies（ANA）,anti dry syndrome antigen B antibody（SSB）,anti-histone antibody（AHA）,and direct immuno fluorescence test were 81. 8%（18 / 22）,76. 9%（20 / 26）,17. 6%（3 / 17）,6. 3%（1 / 16）,and 30. 0%（6 / 20）,respectively. There were 21 patients who stopped PPI after appearance of SCLE. Of them, 14 patients＇ erythema disappeared without any treatment,6 patients＇ erythema disappeared after receiving symptomatic treatment,and one died after switching to other kind of PPI. There were 5 patients who continued to use PPI after appearance of SCLE. Of them,2 patients＇erythra persisted,3 patients died.＆amp;nbsp;Conclusions The characteristics of patients with SCLE due to PPI included the following：most of the patients were more than 50 years old,female,and having history of autoimmune diseases. The key action of improving the prognosis after appearance of SCLE is to stop the medicine immediately.