抗癫痫药致噬血细胞性淋巴组织细胞增生症的文献分析

Literature Analysis of Hemophagocytic Lymphohistiocytosis Induced by Antiepileptic Drugs

目的:了解抗癫痫药相关噬血细胞性淋巴组织细胞增生症(HLH)的临床特点。方法:检索PubMed、OVID、Embase、中国知网、万方数据库和维普数据库(截至2022年3月),收集抗癫痫药相关HLH的个案报道类文献,记录患者基本情况(年龄、性别和原发病等)、致敏药物、用药剂量和联合用药,以及HLH发生时间、临床表现、处置和转归等信息,进行描述性统计分析。结果:共收集个案报道类文献20篇,涉及22例患者,其中男性14例,女性8例;年龄3~59岁;应用拉莫三嗪18例,苯巴比妥2例,奥卡西平1例,同时使用卡马西平、苯妥英和托吡酯1例;17例报告了出现HLH的时间,HLH发生时间最短和最长的药品均为拉莫三嗪,分别为用药后第6日和第42日。抗癫痫药致HLH的典型临床表现主要为发热、皮疹及多脏器损害。停用抗癫痫药并使用糖皮质激素、依托泊苷、免疫球蛋白等治疗,19例患者的症状在数日至数月内逐渐改善,3例患者最终死亡。结论:应关注抗癫痫药所致HLH,加强用药教育,早期识别和停止使用致敏药物,结合相关治疗患者症状可改善,但严重者可致死亡。

OBJECTIVE:To investigate the clinical characteristics of hemophagocytic lymphohistiocytosis(HLH)induced by antiepileptic drugs.METHODS:PubMed,OVID,Embase,CNKI,Wanfang Data and VIP(up to Mar.2022)were retrieved to collect the case reports on HLH induced by antiepileptic drugs,and the basic information of patients(age,gender,primary disease),sensitized antiepileptic drugs,drug doses and drug combination were recorded.Descriptive statistical analysis was performed on occurrence time,clinical manifestations,treatment and outcomes of HLH.RESULTS:A total of 20 case reports of 22 patients were collected,including 14 males and 8 females.Age ranged from 3 to 59 years old.Among them,18 cases were treated with lamotrigine,2 cases with phenobarbital,1 case with oxcarbazepine,and 1 case with carbamazepine,phenytoin and topiramate.There were 17 cases mentioned the time of HLH,the shortest and longest time were lamotrigine,which was the 6th and 42nd days after treatment,respectively.The typical clinical manifestations of HLH induced by antiepileptic drugs were fever,rash and multiple organ damage.After stopping antiepileptic drugs and using glucocorticoids,etoposide,immune globulin,the symptoms of 19 patients were improved within a few days to several months,and 3 patients died.CONCLUSIONS:Attention should be paid to HLH induced by antiepileptic drugs,drug education should be strengthened,early identification and discontinuation of sensitized antiepileptic drugs.Combined with relevant treatment,the symptoms of patients can be improved,yet severe cases can lead to death.