药物超敏反应综合征14例漏误诊原因分析

Missed Diagnosis and Misdiagnosis Analysis of 14 Cases of Drug-induced Hypersensitivity Syndrome

目的探讨药物超敏反应综合征(DIHS)的临床特点以及漏误诊原因。方法回顾性分析2014年1月—2018年10月住院诊断为重症药疹的患者,按照RegiSCAR评分系统筛选出DIHS的病例,将其他重症药疹患者纳入非DIHS组。记录2组的致敏药物、一般资料、临床症状、实验室检查等,并对相关数据进行统计分析。结果本次研究重症药疹37例,经RegiSCAR评分系统筛选DIHS 14例(漏误诊率37.84%)。DIHS患者中常见的致敏药物为抗生素类,其次为非甾体抗炎药。DIHS患者以发热(主要为高热)、嗜酸粒细胞升高、淋巴结肿大及肝功能损伤多见,可出现面部肿胀、异型淋巴细胞,且在糖皮质激素减量过程中易复发。DIHS组与非DIHS组白细胞异常、嗜酸粒细胞升高、天冬氨酸转氨酶>100 U/L患者比较差异有统计学意义(P<0.05,P<0.01)。14例DIHS经治疗后,7例好转出院,1例痊愈出院,1例自动出院失访,2例转上级医院,3例死亡;治疗有效率57.14%,病死率21.43%。3例死亡患者病情进展极为迅速,均出现内脏器官损伤,2例为多器官功能衰竭。结论重症药疹患者应进行RegiSCAR评分系统评分,提高该病的早期诊断率。DIHS病情进展快,病死率高,应加强对本病的认识,尽量避免漏诊及误诊,及时停用致敏药物,把握治疗时机,降低该病病死率。

Objective To investigate the clinical characteristics and causes of missed diagnosis and misdiagnosis of drug-induced hypersensitivity syndrome(DIHS).Methods A retrospective analysis was conducted on clinical data of patients who had admitted for severe drug eruption during January 2014 and October 2018.According to the RegiSCAR scoring system,the patients with DIHS were selected,and other patients with severe drug eruption were included in the non-DIHS group.The sensitizing drugs,general information,clinical symptoms and laboratory tests of the two groups were recorded,and the relevant data were statistically analyzed.Results A total of 37 cases of severe drug eruption were included in this study,and 14 DIHS cases were included based on the RegiSCAR scoring system(37.84%missed/misdiagnosis rate).The most common sensitizing drugs in DIHS patients were antibiotics,followed by NSAIDs.In patients with DIHS,fever(mainly high fever),increased eosinophils,enlarged lymph nodes and liver function damage were more common.Facial swelling,atypical lymphocytes,and recurrence in the process of glucocorticoid reduction were common in patients with DIHS.There were statistically significant differences between DIHS group and non-DIHS group in abnormal white blood cells,increased eosinophils,and aspartate aminotransferase more than 100 U/L(P<0.05,P<0.01).After treatment for the 14 DIHS cases,7 cases were improved and discharged;1 case recovered and discharged;1 case was discharged voluntarily and lost to follow-up;2 cases were transferred to higher-level hospitals,and 3 cases died.The effective rate of treatment was 57.14%,and the mortality rate was 21.43%.The conditions of the 3 dead patients progressed extremely rapidly,all of them had internal organ damage,and 2 patients had multiple organ failure.Conclusion The patients with severe drug eruption should be scored with RegiSCAR scoring system to improve the early diagnosis rate of the disease.DIHS condition progresses rapidly and has a high fatality rate.Therefore,we should strengthen understanding of the disease,avoid missed diagnosis and misdiagnosis,stop sensitizing drugs in time and grasp the timing of treatment to reduce the fatality rate of patients.