头孢菌素类药物罕见不良反应DRESS综合征文献分析

Literature analysis of rare adverse reactions of DRESS syndrome caused by cephalosporins

目的:总结头孢菌素类药物致伴嗜酸性粒细胞增多和系统症状的药疹综合征(drug reaction with eosinophilia and systemic symptoms syndrome,DRESS综合征)的发生情况及特点,为临床安全合理用药提供参考。方法:检索国内外相关数据库,收集头孢菌素类药物导致DRESS综合征的病例报道,对筛选出的病例进行统计和分析。结果:共收集到有效文献34篇,涉及患者36例,男性22例(61.11%),女性14例(38.89%);致敏药物为第三代头孢菌素的病例数共24例(66.67%);头孢菌素类药物致DRESS综合征的潜伏期均值为(19.40±11.25)d;24例(66.67%)患者在用药14 d之后出现不良反应;临床症状主要表现为发热、皮疹、面部水肿、淋巴结肿大、嗜酸性粒细胞增高及内脏受累,最常见受累的器官为肝脏24例(66.67%),其次是肾脏11例(30.56%)。所有患者在予以皮质类固醇、抗病毒药物、抗组胺药物、皮质类固醇联合乙酰半胱氨酸、免疫球蛋白、免疫抑制剂和贝那利珠单抗等治疗后,33例(91.67%)好转,1例(2.78%)患者结局未知,2例(5.56%)患者死亡,其中1例死于多器官功能衰竭,1例死于急性心肌心包炎。结论:头孢菌素类药物致DRESS综合征的患者各年龄段均有发生,多数患者潜伏期大于14 d;致敏药物主要以第三代头孢菌素为主;早期诊断和停用致敏药物对改善患者的预后至关重要。皮质类固醇、抗病毒药物、免疫球蛋白、免疫抑制剂、贝那利珠单抗等治疗药物有益DRESS综合征患者的预后。临床上应提高对头孢菌素类药物可能导致DRESS综合征的认识和处置水平,以减少不良反应的发生。

OBJECTIVE To summarize the occurrences and characteristics of drug reaction with eosinophilia and systemic symptoms syndrome(DRESS syndrome)caused by cephalosporin to provide references for clinical safe and rational drug dosing.METHODS The relevant domestic and international databases were searched for case reports of DRESS syndrome caused by cephalosporin.The retrieved cases fulfilled the standards for statistics and analysis.RESULTS A total of 34 eligible items were collected.There were 22 males(61.11%)and 14 females(38.89%).A total of 24 cases(66.67%)received third-generation cephalosporins as sensitizers.The average latency of DRESS syndrome caused by cephalosporins was(19.40±11.25)day.And 24 patients(66.67%)experienced adverse reactions after 14-day medication.The major clinical symptoms included fever,rash,facial edema,lymphadenopathy,elevated eosinophils and visceral involvement.The most common affected organs were liver(n=24,66.67%)and kidney(n=11,35.48%).After receiving corticosteroids,antiviral drugs,antihistamines,corticosteroids plus acetylcysteine,immunoglobulins,immunosuppressants and benazezumab,the outcomes were improvement(n=33,91.67%),unknown(n=1,3.23%)and death(n=2,5.56%).The mortality causes were multiple organ failure(n=1)and acute myocardial pericarditis(n=1).CONCLUSION DRESS syndrome caused by cephalosporin may occur in all age groups with an incubation period of over 14 days.The major allergens are third-generation cephalosporins.Early diagnosis and timely discontinuation are crucial for improving patient outcomes.Corticosteroids,antiviral drugs,immunoglobulins,immunosuppressants and benazezumab are beneficial.In clinical practices,it is necessary to improve the understanding and management level of cephalosporins causing DRESS syndrome to lower the occurrence of adverse reactions.