皮肤科住院药疹患者154例回顾性分析

Clinical analysis of 154 inpatients with drug eruption

目的探讨皮肤科住院药疹患者的临床特征,病因药物、药疹类型,进行诱发药疹相关因素分析,为临床合理用药及预防药疹的发生提供参考。方法回顾分析滨州医学院附属附属医院皮肤科2011年1月至2018年6月间收治的154例确诊为药疹患者的原发疾病、用药种类、药疹类型、致敏药物、潜伏期、系统损害、治疗等临床数据。结果药疹病例占皮肤科同期住院总病例的7.1%。原发疾病以感染性疾病最多,为84例(54.5%)。单一用药115例(74.7%),混合用药39例(25.3%)。单一用药患者中前3位的病因药物类别为抗生素、解热镇痛药、镇静催眠抗癫痫药;前3位的药物品种为β内酰胺类(33例)、对乙酰氨基酚(20例)、卡马西平(11例);应用中成药者(9例)。154例患者中,轻型药疹116例,重型药疹38例(38.3%)。共有139例(90.3%)药疹患者应用了糖皮质激素,其中5例重型药疹患者联合使用了静脉注射丙种球蛋白治疗。154例重症药疹中未随访到死亡病例。结论抗生素、解热镇痛药、镇静催眠抗癫痫药是前三位的病因药物种类,β内酰胺类、对乙酰氨基酚、卡马西平为其代表性药物,中成药为第四位的病因药物种类。重型药疹的病因药物中解热镇痛药、镇静催眠抗癫痫药占比增大,潜伏期更长,合并发热及系统损害更多见。感染对药疹的发生、发展和转归有一定影响。

Objective To investigate the causative drugs,clinical types and the relationship between them. Methods Clinical data were collected from 154 inpatients with drug eruption in Binzhou medical college affiliated hospital,January 2011 to June 2018,and analyzed retrospectively. Results The percentage of inpatients with drug eruption among all inpatients in the Department of Dermatology was 7.1%.Infectious diseases(84 cases,54.5%) were the most of primary diseases.115 (74.7%) were caused by single drugs,and 39 (25.3%) by multiple drugs.Among the 115 cases of drug eruption caused by single drugs,the top three causative drugs were β-lactam antibiotics(33 cases),acetaminophen(20 cases) and carbamazepine (11 cases) in non-severe drug eruption,and severe drug eruption.Traditional Chinese medicine(9 cases)was another causative drug in non-severe drug eruption.Of the 154 patients,116 presented with non-severe eruption and 38 with severe eruption.A total of 139 (90.3%) patients with drug eruption received glucocorticoid treatment.Totally,5 patients with drug eruption were treated with combined intravenous immunoglobulin (IVIG) because of poor response to glucocorticoids alone.No cases were followed up to death. Conclusion β-lactam antibiotics,acetaminophen and carbamazepine were the main causative drugs for severe and non-severe drug eruption,while traditional Chinese medicine was another important causative drug for non-severe drug eruption.Infection is a certain influence factor on the occurrence,development and prognosis of drug eruption.