儿童药物超敏反应综合征15例临床分析

Clinical analysis of 15 cases of drug-induced hypersensitivity syndrome in children

目的探讨儿童药物超敏反应综合征(DIHS)的临床特点、治疗方法及预后。方法回顾性分析2013年8月至2022年9月在郑州大学第一附属医院住院治疗的15例DIHS病儿的致敏药物、潜伏期、临床表现、实验室检查、并发症及预后。结果15例病儿致敏药物以β内酰胺类抗生素、抗癫痫药物为主。中位潜伏期14.5(10.0,22.3)d。15例病儿均有反复发热、全身红色皮疹伴瘙痒、脏器损害等,其中肝损害14例(93.33%),肾脏损害1例(6.67%),心肌损害7例(46.67%)。浅表淋巴结肿大8例(53.33%),嗜酸粒细胞及异型淋巴细胞增高各有6例(40.00%)。严重的合并症包括转氨酶升高10倍以上8例,占53.33%,合并肝衰竭、肝性脑病、多脏器衰竭死亡1例。治疗主要为停用致敏药物,及时使用糖皮质激素,必要时可联合丙种球蛋白冲击治疗及血浆置换等。12例病儿治愈出院,2例病儿在我院治疗好转后转至上级医疗机构进一步诊治,1例病儿因多脏器损害死亡。结论DIHS是一种严重药物不良反应,具有潜在致死性,早期足量糖皮质激素必要时联合丙种球蛋白冲击治疗可有效控制病情。

Objective To investigate the clinical characteristics,treatment methods and prognosis of drug-induced hypersensitivity syndrome(DIHS)in children.Methods The sensitizing drugs,incubation period,clinical manifestations,laboratory tests,complication and prognosis of 15 children with DIHS hospitalized in the First Affiliated Hospital of Zhengzhou University from August 2013 to September 2022 were retrospectively analyzed.Results The main sensitizing drugs wereβ-lactam antibiotics and antiepileptic drugs.The median incubation period was 14.5(10.0,22.3)days.All the 15 children had recurrent fever,systemic red rash with pruritus and organ damage,including liver damage in 14 cases(93.33%),kidney damage in 1 case(6.67%)and myocardial damage in 7 cases(46.67%).Superficial lymph node enlargement was found in 8 cases(53.33%),and eosinophils and heterogeneous lymphocytes were increased in 6 cases(40.00%).Severe complications included 8 cases with a 10-fold increase in transaminase,accounting for 53.33%,and 1 case died of hepatic failure,hepatic encephalopathy,and multiple organ failure.The main treatment was to stop the use of allergenic drugs,timely use of glucocorticoid,combined with gamma globulin and plasma exchange if necessary.Twelve cases were cured and discharged,2 children were transferred to superior medical institutions for further treatment after treated in our hospital,and 1 child died due to multiple organ damage.Conclusion DIHS is a serious adverse drug reaction and may be fatal.Early sufficient glucocorticoid,if necessary,combined with gamma globulin pulse therapy can effectively control the disease..