拉莫三嗪严重免疫相关不良反应文献分析

Literature Analysis of the Serious Immune-related Adverse Reactions of Lamotrigine

目的分析拉莫三嗪引起的严重免疫相关不良反应,为临床安全用药提供参考。方法系统检索国内外文献报道的相关不良反应个例、综述、研究等,综述拉莫三嗪引起严重免疫相关不良反应的表现、特征、发生机制。结果拉莫三嗪可引起严重免疫相关不良反应,包括Stevens-Johnson综合征、中毒性表皮坏死松解症、伴嗜酸性粒细胞增多和系统症状的药物反应、免疫性溶血性贫血、系统性红斑狼疮、假性淋巴瘤、边缘性脑炎以及噬血细胞性淋巴组织细胞增生症等。发生时间从用药后几天到数年不等。不同免疫相关不良反应具有不同的发生机制,有的不良反应罕见但非常严重甚至致命。结论医务人员应关注拉莫三嗪严重免疫相关不良反应风险,及时诊断治疗。建议生产企业加强研究,在说明书增加有关不良反应警示,避免严重后果发生。

Objective To analyze the serious immune-related adverse reactions caused by lamotrigine and provide reference for the clinical rational drug use. Methods The related adverse reactions reported in domestic and foreign literatures were systematically retrieved, such as cases, reviews, studies, etc., and the manifestations, characteristics and mechanism of lamotrigine-induced severe immune-related adverse reactions were reviewed. Results Lamotrigine can cause serious immune-related adverse reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, immune hemolytic anemia, systemic lupus erythematosus, pseudolymphoma, limbic encephalitis, and hemophagocytic lymphohistiocytosis, occurring from a few days to several years after administration. Different immune-related adverse reactions have different mechanisms of occurrence, and some adverse reactions are rare but very severe or even fatal. Conclusion Medical staff should pay attention to the risk of serious immune-related adverse reactions of lamotrigine and timely diagnosis and treatment. It is recommended that manufacturers strengthen research and increase warnings about adverse reactions in the instructions to avoid serious consequences.