卡马西平和拉莫三嗪所致皮疹的临床特征及危险因素分析  

Clinical features and risk predictors of skin rashes induced by carbamazepine and lamotrigine

作　　者：何娜[1] 民福利[1] 石奕武[1] 刘晓蓉[1] 黎冰梅[1] 廖卫平[1] 

机构地区：[1]广州医科大学附属第二医院神经内科和神经科学研究所,广东省和教育部神经遗传和离子通道重点实验室,510260

出　　处：《实用医学杂志》2016年第22期3760-3764,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金资助项目(编号:81301107);羊城学者学术带头人项目(编号:12A017G);广州医科大学博士科研项目(编号:2012C44)

摘　　要：目的:比较分析卡马西平(CBZ)和拉莫三嗪(LTG)所致皮疹的临床特征,探寻两者所致皮疹的临床危险因素。方法:收集近7年在我院癫痫专科就诊并首次接受CBZ和LTG规范治疗的癫痫患者的临床资料,比较分析二者所致皮疹的发生率、临床特点和临床危险因素。结果:共有992例癫痫患者规范服用CBZ,其中38例(3.8%)出现皮疹;613例服用LTG,18例(2.9%)发生皮疹,两组皮疹发生率比较差异无显著性(P>0.05)。CBZ皮疹组中,重型皮疹SJS/TEN占比34.2%(13/38);而LTG皮疹组中仅1例表现为SJS/TEN(5.6%,1/18),差异具有统计学意义(P=0.023)。CBZ皮疹组的平均潜伏期为13.5 d,而LTG皮疹组为17.7 d,两组比较差异有显著性(P=0.007)。CBZ皮疹组和LTG皮疹组中具有过敏史的患者比例均明显高于CBZ非皮疹组(P=0.001)和LTG非皮疹组(P=0.002)。其他因素如年龄、性别、起始剂量、合并药物等在两组间比较差异无统计学意义。结论:过敏史是CBZ和LTG所致皮疹的共同危险因素。因此,临床上对具有过敏史的患者应慎重选择CBZ和LTG,减少或避免皮疹的发生。Objective To compare the clinical features and explore the potential risk predictors of skin rashes induced by carbamazepine （CBZ） and lamotrigine （LTG）. Methods Epilepsy patients with firstly stan- dardized administration of CBZ and LTG were recruited from our Epilepsy Center within recent 7 years. The inci- dence and clinical features of rashes induced by CBZ and LTG were summarized and compared, and the clinical risk predictors were analyzed. Results A total of 992 patients with standardized administration of CBZ were en- rolled, and among them 38 cases experienced skin rashes （3.8%）. Another 613 patients with standardized ad- ministration of LTG were collected, and 18 cases of them （2.9%） suffered rashes. The rash incidence of CBZ and LTG showed no significant difference （P 〉 0.05）. Thirteen cases in CBZ-rash group （13/38, 34.2%） de- veloped Steven-Johnson syndrome and toxic epidermal neerolysis （SJS/TEN）, but only 1 （1/18, 5.6%） in LTG-rash group （P = 0.023）. The average latency of CBZ-rash was 13.5 d, significantly shorter than that of LGT-rash （17.7 d, P = 0.007）. History of allergy appeared significantly more often in rash patients than in non- rash patients for both CBZ （P = 0.001） and LTG （P = 0.002）. Other risk predictors, such as age, gender, ini- tial dosage and concomitant drugs, showed no statistical differences between rash group and non-rash group. Conclusions History of allergy is a common risk factor for CBZ-rash and LTG-rash. To reduce or avoid the rashes, we should take caution against prescribing CBZ and LTG for patients with a history of allergy.

关 键 词：皮疹 卡马西平 拉莫三嗪 临床危险因素 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]