药物致妊娠期急性泛发型发疹性脓疱病文献病例分析

Literature case analysis of acute generalized exanthematous pustulosis in pregnancy induced by drugs

目的研究引起妊娠期急性泛发型发疹性脓疱病的药物种类及该病的临床表现、病程特点和愈后情况。方法检索PubMed、EMBASE、Web of Science、中国知网、万方数据库、维普数据库、中华医学会期刊全文数据库(截至2023年4月30日),收集药物致妊娠期AGEP的病例信息【国籍、年龄、孕周、过敏史、银屑病史、诱因、用药途径(药物)、发病时间、临床表现及辅助检查、处置及转归、皮肤活检情况】,并对其进行描述性统计分析。结果纳入患者14例,包括早期妊娠2例、中期妊娠4例和晚期妊娠8例,平均年龄32岁(23~39岁);1例诱因为流感疫苗,其余13例均考虑由药物【抗菌药物7例(53.85%)和米非司酮、拉贝洛尔、奥美拉唑、羟氯喹、对乙酰氨基酚、间苯三酚各1例(7.69%)】引发。发病时间从几小时到几十天不等。所有患者均愈后良好,转归时间2~15 d。不同妊娠时期和不同用药途径的发病时间、转归时间均无统计学差异(P>0.05)。结论多种临床常用药物可引发妊娠期AGEP,大多发生在用药3 d内,临床表现典型,及时停药后酌情予对症支持治疗,愈后良好。

Objective To explore the characteristics of drugs inducing acute generalized exanthematous pustulosis during pregnancy,and the clinical features,disease course and outcomes of the disease.Methods The relevant databases including PubMed,EMBASE,Web of Science and four Chinese native databases were searched and literature on AGEP in pregnancy were reviewed.The information of patients[nationality,age,gestational course,history of allergy,history of psoriasis,causes,usage(drugs),time of onset,clinical manifestations and examinations,treatments and outcomes,skin biopsy results]were collected and descriptively analyzed.Results A total of 14 patients were included,2 in the first trimester,4 in the second trimester and 8 in the third trimester.The mean age was 32 years old(from 23 to 39 years old).Apart from 1 case was triggered by vaccine,the other 13 cases were all considered to be caused by drugs[7(53.85%)for antibiotics and 1(7.69%)for each of mifepristone,labetalol,omeprazole,hydroxychloroquine,acetaminophen,phloroglucinol].The onset time ranged from hours to dozens of days.All patients were cured after 2~15 days.There're no statistical differences in onset time or recovery duration among different stages of pregnancy or routes of administration(P>0.05).Conclusion AGEP in pregnancy could be induced by drugs in very common use,and mostly triggered within 3 days with typical clinical manifestations.With suspected drugs stopped and symptomatic/supportive treatments,the recovery was always good.