344例药疹住院患者临床分析

Drug eruption:Clinical analysis in 344 inpatients

目的:探讨药疹住院患者的临床特征及常见致敏药物。方法:对2011年10月~2018年12月于弋矶山医院皮肤科确诊的344例药疹住院患者病历资料进行分析。结果:所有药疹住院患者中,多形红斑型(39.2%);发疹型(23.3%);急性泛发型发疹性脓疱病(14.5%);荨麻疹型(4.9%);紫癜型(2.3%);固定型(0.3%);重症多形红斑型(7.6%);中毒性大疱表皮松解型(5.8%);剥脱性皮炎型(1.2%);药物超敏反应综合征(0.9%)。抗生素占致敏药物第1位(38.1%),其余为中草药类(13.4%)、抗痛风药(13.1%)、抗癫痫类(5.2%)、解热镇痛类(4.4%)、磺胺类(1.5%)、其他类(3.5%)、不详(20.9%)。结论:该区域以多形红斑型药疹最多见;非重症中,抗生素和中草药是两类最主要的致敏药物;重症中,别嘌醇是主要的致敏药物;有黏膜受累者往往提示病情加重,肝肾等内脏系统受累;微量静脉泵24 h持续泵入糖皮质激素联合静脉注射免疫球蛋白(IVIG)治疗重症药疹患者,疗效明确。

Objective:To investigate clinical pictures of drug eruption in inpatients and the most common causative drugs.Methods:Medical records were collected from 344 inpatients confirmed with drug eruptions in our department between October 2011 and December 2018,and retrospectively anaalyzed.Results:In all inpatients,the clinical sign was primarily presented with erythema multiform(39.2),exanthematous drug eruption(23.3%),acute generalized exanthematous pustulosis(14.5%),urticarial drug eruption(4.9%),purpuric drug eruption(2.3%),fixed drug eruption(0.3%),stevens-Johnson syndrome(7.6%),toxic epidermal necrolysis(5.8%),exfoliative dermatitis drug eruption(1.2%)and drug-induced hypersensitivity syndrome(0.9%).The most implicated drugs were antibiotics(38.1%),followed by Chinese herbal medicine(13.4%),anti-gout drugs(13.1%),antiepileptic(5.2%),antipyretic and analgesic(4.4%),sulfonamides(1.5%),other(3.5%)and unknown agents(20.9%).Conclusion:The most common drug eruption is characterized by erythema multiform.In non-severe cases,antibiotics and Chinese herbal medicines are the top two kinds of causative drugs,whereas in severe cases,the primarily implicated drug is allopurinol.Patients with mucosal involvement often indicate aggravated disease,with visceral system such as liver and kidney being involved.Patients can well respond to continuous infusion of glucocorticoid with microvenous pump for 24 hours combined with intravenous immunoglobulin(IVIG).