重症药疹55例临床分析

Clinical Analysis of 55 Cases of Severe Drug Eruption

目的探讨重症药疹的致敏药物、发生规律、临床特征和治疗措施。方法对2011年1月-2016年1月本院收治的55例重症药疹患者的临床资料进行回顾性分析。结果 55例重症药疹患者中,男女比例为7∶4,以重症多形红斑型药疹最为多见(26,47.27%),单种致敏药物以抗生素及抗癫痫药为首位,各9例(16.36%),抗癫痫药以卡马西平最常见,共8例(14.55%),抗生素类药物以头孢、青霉素类多见6例(11.32%)。多种抗生素联用9例(16.36%),抗生素联合解热镇痛药有6例(11.32%),抗生素联合抗癫痫药1例(1.82%),镇静类药1例(1.82%)。黏膜损害34例(61.81%),肝功能损害31例(56.36%)。均予系统用糖皮质激素治疗,其中7例(12.73%)联合人免疫球蛋白治疗。结论重症药疹中以重症多形红斑型药疹居多,抗生素类药物及抗癫痫药是引起重症药疹最常见的药物,多种药物联合应用比例偏高。重症药疹常出现黏膜损伤和肝功能损伤。系统应用糖皮质激素尤其是联合人免疫球蛋白治疗重症药疹有效。

Objective To investigate the allergenic drugs, regularity, clinical features and therapy for severe drug eruption. Methods The clinical data of 55 hospitalized patients with severe drug eruption from January 2011 to January 2016 were reviewed retrospectively. Results Male-to-female ratio of these patients was 7： 4. The most common type of severe drug eruption was Stevens-Johnson syndrome（ SJS,26 cases, 47.27% ）. The major allergenic drugs were antiepileptics （9 cases, 16. 36% ） and antibiotics （9cases, 16. 36% ）. The most common antiepileptic drug was carbamazepine （8 cases, 14. 55% ）. Cephalosporin and penicillin （6 cases, 11.32% ） were common antibiotic drugs causing severe drug eruption. 9 cases （ 16. 36% ） were caused by multiple types of antibiotics. 6 cases （ 11.32% ）were caused by combination of antibiotics and antipyretic analgesics, and one patient （ 1.82% ） after using antibiotics and antiepileptic drugs. One case was allergic to sedative drugs（1.82% ）. Mucosal （34 cases, 61.81% ） and liver damages （31 cases, 56. 36% ） damage were common damages in severe drug eruptions. All 55 cases of severe drug eruption were treated with systemic corticosteroids,and 7 cases were given additional treatment with immunoglobulin. Conclusion The most common type of severe drug eruption is Stevens-Johnson syndrome. Antiepileptics and antibiotics are common causative drugs. The incidence of multiple drug caused drug eruption is higher than that previously reported. Systemic corticosteroids, especially combined immunoglobulin, are effective for severe drug eruption.