多粘菌素B导致皮肤色素沉着药品不良反应的文献分析

Literature analysis of skin hyperpigmentation induced by polymyxin B

目的:分析多粘菌素B致皮肤色素沉着药品不良反应(ADRs)的临床特点及可能的发生机制。方法:系统检索PubMed、EmBase、Cochrane Library、中国期刊全文数据库(中国知网,CNKI)、万方数据-数字化期刊群中关于多粘菌素B致皮肤色素沉着ADRs的个案报道,结合作者在工作中观察到的病例,进行汇总分析。结果:检索到14篇个案报道(涉及18例患者),加上作者在工作中观察到的1例病例,共19例患者,其中男性12例(63.2%),女性4例(21.1%),性别未知3例(15.8%)。老年患者(≥65岁)占总例数的26.3%。多粘菌素B相关皮肤色素沉着发生在用药后3~29 d,其中14例(73.7%)患者皮肤色素沉着发生在用药后14 d;报道的转归患者有9例,其中4例在停药后45 d至3个月后恢复至原本肤色。多粘菌素B致皮肤色素沉着的机制可能涉及组胺释放、朗格汉斯细胞增殖、氧化应激反应及苯丙氨酸增加黑色素的合成。结论:多粘菌素B导致的皮肤色素沉着较为常见,症状多发生于用药早期,多累及面部和颈部。该ADRs可逆,停药后数月可恢复至原本肤色,其发生机制尚不明确,有待于进一步研究。

Objective:To analyze the clinical characteristics of skin hyperpigmentation induced by polymyxin B and possible mechanism involved.Methods:Case reports of skin hyperpigmentation induced by polymyxin B were retrieved from PubMed,EmBase,Cochrane Library,China National Knowledge Infrasructure(CNKI)and Wanfang Data Digitalization Journals.The obtained data combined with a case encountered in clinical work were summarized and analyzed.Results:14 case reports involving 18 patients were retrieved,and there was another case encountered in clinical work,totalling 19 patients,of whom 12(63.2%)were male patients,4(21.1%)were female patients and 3(15.8%)were of unknown gender.Elderly patients(≥65 years old)accounted for 26.3%.3-29 days after medication,there occurred cases of polymyxin B-related skin hyperpigmentation,of which 14(73.7%)occurred 14 days after medication.There were 9 patients with reported clinical outcomes,and the skin color of the 4 patients returned to normal 45 days to 3 months after cessation of the drug.The mechanism of skin hyperpigmentation induced by polymyxin B might be associated with histamine release,Langerhans cell proliferation,oxidative stress response and increased melanin synthesis by phenylalanine.Conclusion:Skin hyperpigmentation induced by polymyxin B is commonly seen in clinical practice,and the symptoms usually develop in the early stage after medication,mostly affecting the face and neck.The adverse drug reactions are reversible and the original skin color could return to normal several months after drug withdrawal.However,the possible mechanism involved remains unknown,which demands further research.