头孢菌素类药物致史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症的文献分析

Literature analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis caused by cephalosporins

目的:分析头孢菌素类药物致史蒂文斯-约翰逊综合征(SJS)和中毒性表皮坏死松解症(TEN)不良反应发生情况及其临床特点,为临床安全用药提供参考。方法:检索Web of Science、PubMed、中国知网数据库、维普数据库和万方数据库关于头孢菌素类药物致SJS/TEN的文献报道并进行分析。结果:共纳入文献25篇,26例不良反应,其中,男性15例(57.69%),女性11例(42.31%);年龄最小5岁,最大85岁,中位年龄61.5岁;SJS 9例(34.62%),TEN 17例(65.38%);发生时间集中在用药后3 d内的13例(50.01%);临床表现以皮肤伴有或不伴渗出多型红斑、斑丘疹为主的皮疹伴发热、口腔、生殖器和或眼黏膜破溃,随着病程进展进而出现皮肤水疱破裂及脱落,常伴有继发性感染及多脏器损害,以肝肾损害较常见。结论:临床应用头孢菌素类药物存在SJS/TEN的风险,医务人员应了解其发病特点及早期鉴别SJS/TEN症状,一旦发生应根据患者严重程度尽早给予对症治疗,降低SJS/TEN的病死率,加强后期随访及患者用药教育。

OBJECTIVE To explore the occurrence and clinical characteristics of adverse reactions of Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)caused by cephalosporins to provide references for clinical dosing safety.METHODS Case reports on SJS/TEN caused by cephalosporins were analyzed by searching the databases of Web of Science, PubMed, CNKI,VIP and WanFang. RESULTS A total of 25 references were included, with 26 cases of adverse reactions, including 15 males(57.69%)and 11 females(42.31%).The age ranged from 5 to 85 years with a median age of 61.5 years.There were 9 cases(34.62%)of SJS and 17 cases(65.38%)of TEN.The occurring time was concentrated in 13 cases(50.01%)within Day 3 after medication.Clinical manifestations included skin rash with or without multiple erythema and papules, accompanied by fever, oral cavity, genital and eye mucous membrane rupture, skin blister rupture and abscess as disease progresses, often accompanied by secondary infection and multiple organ damage, especially liver and kidney.CONCLUSION Clinical application of cephalosporins has the risk of SJS/TEN.Physicians should understand its pathogenetic characteristics and early identification of SJS/TEN symptoms.Based upon disease severity, symptomatic treatment should be offered to reduce the mortality of SJS/TEN and strengthen follow-ups and medication education.