住院药疹患者的临床资料分析

Analysis of clinical data of inpatients with drug eruptions

目的探讨临床住院药疹患者致敏药物分类、皮疹类型、治疗及转归。方法选取空军特色医学中心皮肤科2015年1月至2019年9月收治的药疹患者121例,根据药疹严重程度分为重症组22例,非重症组99例。回顾性分析患者的致敏药物分类、皮疹类型、单一致敏药物的皮疹类型分布、治疗及转归,比较2组患者的性别和年龄、基础疾病患病率、既往过敏史比例、临床表现、实验室检查结果异常情况及住院时间。结果121例药疹患者中21~40岁56例(46.3%),发病率最高。重症组22例,皮疹类型为重症多形红斑型13例(59.1%)、大疱性表皮坏死松解型6例(27.3%)、剥脱性皮炎型2例(9.1%)及药物超敏反应综合征1例(4.5%);非重症组99例,皮疹类型为发疹型30例(30.3%)、荨麻疹型22例(22.2%)、湿疹型20例(20.2%)、多形红斑型19例(19.2%)、紫癜型7例(7.1%)、固定型1例(1.0%)。121例药疹患者中明确单一致敏药物者75例,其中抗菌药物类33例(27.3%)、中药13例(10.7%)、解热镇痛药12例(9.9%)及抗癫药物8例(6.6%);46例为联合用药所致。重症组基础疾病患病率、既往过敏史比例与非重症组比较差异均无统计学意义(均P>0.05)。重症组患者黏膜受累、发热、C反应蛋白升高和肝功能异常比例均高于非重症组(均P<0.05)。所有患者均痊愈出院,重症组平均住院时间长于非重症组[(22±14)d比(10±5)d](t=3.62,P=0.02)。结论临床常见致敏药物为抗菌药物、中药、解热镇痛药及抗癫药;非重症组最常见的药疹类型为发疹型,重症组为重症多形红斑型;重症药疹易合并黏膜受累、发热及肝功能异常;早期足量系统使用糖皮质激素是治疗重症药疹的关键。

Objective To investigate the classification of allergenic drugs,type of drug eruptions,treatment and outcome of hospitalized patients with drug eruption.Methods A total of 121 patients with drug eruption who were hospitalized in the dermatology department of Air Force Medical Center from January 2015 to September 2019 were selected.According to the severity of drug eruption,they were divided into severe drug eruption group(22 cases)and non-severe drug eruption group(99 cases).The classification of allergenic drugs,type of drug eruptions,distribution of single sensitizing drugs,treatment and outcome of the 121 inpatients were retrospectively analyzed.The gender,age,prevalence of underlying diseases,proportion of previous allergy history,clinical manifestations,abnormal laboratory test results and hospital stay of two groups were compared.Results Among the 121 cases of drug eruption,those with 21 to 40 years old[56 cases(46.3%)]had the highest incidence.There were 22 cases in severe drug eruption group,including 13 cases of Stevens-Johnson Syndrome(59.1%),6 cases of toxic epidermal necrolysis(27.3%),2 cases of exfoliated dermatitis(9.1%)and 1 case of drug hypersensitivity syndrome(4.5%).There were 99 cases of drug eruption in the non-severe group,including 30 cases of exanthematous drug eruption(30.3%),22 cases of urticaria drug eruption(22.2%),20 cases of eczematoid drug eruption(20.2%),19 cases of erythema multiform(19.2%),7 cases of purpuric drug eruption(7.1%),and 1 case of fixed drug eruption(1.0%).Among the 121 cases of inpatients with drug eruption,75 cases were identified with single uniform drug,including 33 cases of antibiotics(27.3%),13 cases of traditional Chinese medicine(10.7%),12 cases of nonsteroidal anti-inflammatory drugs(9.9%)and 8 cases of antiepileptic drugs(6.6%).Forty-six cases were caused by combination of drugs.There were no statistically significant differences in the incidence of basic diseases,the proportion of previous allergic history between the severe group and the non-severe group(all P>0.05).The proportion of mucosal involvement,fever,increased C-reactive protein and abnormal liver function in the severe group were higher than those in the non-severe group(all P<0.05).All the patients were cured and discharged,and the average length of stay in the severe group was longer than that in the non-severe group[(22±14)d vs(10±5)d](t=3.62,P=0.02).Conclusion The common clinical sensitizing drugs were antibiotics,traditional Chinese medicines,nonsteroidal anti-inflammatory drugs and antiepileptic drugs.The most common type of drug eruption in the non-severe group was exanthematous drug eruption,while the severe group was Stevens-Johnson Syndrome.Severe drug eruption is easy to be combined with mucous membrane involvement,fever and abnormal liver function.Early and adequate use of glucocorticoids in the system was the key to the treatment of severe drug eruption.