奥卡西平致Stevens-Johnson综合征和中毒性表皮坏死松解症的特点及基因相关性分析

Analysis of the Characteristics and Gene Relationship of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Oxcarbazepine

目的:探讨奥卡西平致Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)的临床特点及其基因多态性。方法:计算机检索中国知网(CNKI)、万方、维普、PubMed、EMBase、SpringerLink等数据库,对有关奥卡西平引起严重皮肤不良反应的个案报道文献进行整理和分析。结果:收集文献12篇,获取奥卡西平引发SJS/TEN的病例报道13例。奥卡西平的严重皮肤不良反应发生于男性多于女性,不良反应大多发生在用药后1~14 d,经过糖皮质激素、抗过敏药物等治疗均能痊愈,没有致死性病例报道。8例患者进行了基因型检测,其中6例患者为HLA-B*1502阳性,2例为HLA-B*1518/B*4001(HLA-B*1502的变异)。结论:应当严密监测奥卡西平的不良反应,注意患者用药教育与随访,必要情况下通过检测HLA-B*1502基因可指导临床合理使用奥卡西平,优化临床用药方案。

OBJECTIVE：To investigate the clinical characteristics and gene polymorphism of oxcarbazepine（OXC）-induced Stevens-Johnson syndrome（SJS） and toxic epidermal necrolysis（TEN）.METHODS：Retrieved from CNKI,Wanfang,VIP,PubMed,EMBase,SpringerLink and other databases,case reports about OXC-induced severe ADR were summarized and analyzed.RESULTS：Twelve literatures were collected,and 13 case reports about OXC-induced SJS/TEN were obtained.Male had more OXC-induced severe skin ADR than female.ADR mostly occurred during 1-14 d after medication.All patients were cured with treatment of glucocorticoid and antiallergy,without death case.Genotyping for 8 patients were performed and 6 of them showed the presence of HLA-B＊1502 allele.While HLA-B alleles of 2 patients were HLA-B＊ 1518/B＊4001,which was the variation of HLA-B＊ 1502.CONCLUSIONS：OXC-induced ADR should be monitored closely.Great importance should be attached to patient education and follow-up program.HLA-B＊ 1502 gene detection should be performed to guide rational use of OXC and optimize clinical drug use plan.