儿童药物超敏反应综合征22例临床分析

Clinical analysis of drug hypersensitivity syndrome in 22 children

目的分析儿童药物超敏反应综合征(DIHS)临床诊断及治疗。方法回顾分析22例DIHS患儿的致敏药物、临床表现、实验室检查、治疗效果、并发症及预后。结果 22例患儿均有用药史并出现发热,90.9%患儿的皮疹表现为麻疹样红斑,肝脏受累占90.9%,肾损害占18.2%,浅表淋巴结肿大占54.5%,嗜酸粒细胞增多占36.4%。严重的合并症包括自身免疫性溶血性贫血1例,转氨酶升高10倍以上3例,合并肝衰竭、肝性脑病、多脏器衰竭死亡1例。治疗主要为系统使用糖皮质激素及丙种球蛋白,必要时可联合血浆置换。结论儿童DIHS潜伏期长,皮损形态以麻疹样皮疹为主,脏器受累多以肝脏为主,仅部分可合并嗜酸性粒细胞增多。糖皮质激素治疗有效。

Objective To analyze the clinical diagnosis and treatment of drug hypersensitivity syndrome(DIHS) in children.Method The allergenic drugs,clinical manifestations,laboratory examinations,treatment effects,complications and prognosis in 22 children with DIHS were analyzed retrospectively.Results All 22 patients had a medication history and fever.Among them,90.9% patients had erythema morbilliforme,90.9% had liver damage,18.2% had renal damage,54.5% had superficial lymph node enlargement and 36.4% had granulocytosis.Five patients had serious complications.One patient was complicated by autoimmune hemolytic anemia,3 patients had transaminase elevated greater than 10 times and 1 patient died due to hepatic failure,hepatic encephalopathy and multiple organ failure.The treatment mainly included the use of glucocorticoid and gamma globulin,and,if necessary,plasma exchange.Conclusion The incubation period of children with DIHS is long,and the skin lesions are mainly erythema morbilliforme.Most of the affected organs are mainly liver,and some of patients can be combined with eosinophilia.Glucocorticoid therapy is effective.