住院药疹922例临床分析  

Clinical analysis of 922 inpatients with drug eruption

作　　者：付晓丹[1] 傅祥评[2] 杨凡萍 朱沁媛 骆肖群[1] 

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040 [2]福建医科大学附属泉州第一医院皮肤科

出　　处：《中华皮肤科杂志》2015年第12期867-870,共4页Chinese Journal of Dermatology

摘　　要：目的：探讨药疹的发病趋势、致敏药物、疹型的变迁和防治方法。方法回顾分析复旦大学附属华山医院皮肤科2009年1月至2013年12月间收治的922例确诊药疹患者的临床资料。结果2009—2013年每年药疹病例占皮肤科同期住院总病例比例波动于9.45％~10.01％，重症药疹占药疹比例波动于17.45％～28.24％。单一用药371例（40.2％），混合用药551例（59.8％）。278例单一用药非重症药疹中排名前5位的致敏药物依次为中药（72例）、头孢菌素类（38例）、阿莫西林（27例）、解热镇痛（26例）、破伤风抗毒素（24例）；93例单一用药重症药疹中排名前5位的致敏药物依次为抗癫痫药（33例）、别嘌醇（28例）、解热镇痛药（7例）、头孢菌素类（6例）、中药（6例）。922例患者中，皮疹类型主要为发疹型（422例，45.8％）、荨麻疹型（259例，28.1％）、重症多形红斑型（135例，14.6％）、中毒性表皮坏死松解症（49，5.3％），另外共确诊药疹伴嗜酸性粒细胞增多和系统症状综合征（DRESS）33例（3.6％）、急性泛发性发疹性脓疱病7例（0.8％）。共791例（85.8％）药疹患者接受了糖皮质激素治疗，以等量泼尼松计算，非重症型药疹（550例）用量为（47.61±12.07）mg/d，重症型药疹（221例）用量为（73.10±18.23）mg/d。共有101例（11.0％）药疹患者因为糖皮质激素治疗后病情控制不佳联合使用静脉注射丙种球蛋白治疗。224例重症药疹中仅2例（0.9％）死亡。结论卡马西平和别嘌醇仍是引起重症药疹的首要致敏药物；在非重症药疹中中药为第1位致敏药物。2009—2013年重症药疹的死亡率明显下降。Objective To investigate the trend in incidence, causative drugs, clinical types and treatment of drug eruption. Methods Clinical data were collected from 922 inpatients with drug eruption in Huashan Hospital, Fudan University from January 2009 to December 2013, and analyzed retrospectively. Results From 2009 to 2013, the percentage of inpatients with drug eruption among all inpatients in the Department of Dermatology in a given year varied from 9.45% to 10.01%, and the percentage of inpatients with severe drug eruption among inpatients with drug eruption from 17.45% to 28.24%. Of the 922 cases, 371 （40.2%）were caused by single drugs, and 551 （59.8%）by multiple drugs. Among the 371 cases of drug eruption caused by single drugs, the top five causative drugs were traditional Chinese medicine（72 cases）, cephalosporins（38 cases）, amoxicillin（27 cases）, antipyretic analgesics（26 cases）and tetanus antitoxin （24 cases）in 278 cases of non-severe drug eruption, antiepileptic agents （33 cases）, allopurinol （28 cases）, antipyretic analgesics （7 cases）, cephalosporins （6 cases）and traditional Chinese medicine （6 cases）in 93 cases of severe drug eruption. Of the 922 patients, 422 （45.8%）presented with maculopapular eruption, 259 （28.1%）with urticaria, 135（14.6%）with Stevens-Johnson syndrome, 49（5.3%）with toxic epidermal necrolysis, 33（3.6%）with drug reaction with eosinophilia and systemic symptoms （DRESS）, and 7 （0.8%）with acute generalized exanthematous pustulosis （AGEP）. A total of 791 （85.8%）patients with drug eruption received glucocorticoid treatment. The dose of glucocorticoids was（47.61 ± 12.07）mg prednisone equivalent per day in 550 patients with non-severe drug eruption, and （73.10 ± 18.23）mg prednisone equivalent per day in 221 patients with severe drug eruption. Totally, 110 （11.0%） patients with drug eruption were treated with combined intravenous immunoglobulin （IVIG）because of poor response to glucocorticoids al

关 键 词：药疹 卡马西平 别嘌醇 治疗结果 糖皮质激素类 免疫法 被动 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]