内蒙古汉族Stevens-Johnson综合征/中毒性表皮坏死松解症患者致敏药物及HLA基因筛查  

Analysis of culprit drugs and screening for human leukocyte antigen genes in patients of Han nationality with Stevens-Johnson syndrome/toxic epidermal necrolysis in Inner Mongolia

作　　者：李欣[1] 韩建文[1] Li Xin;Han Jianwen(Department of Dermatology,The Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010010,China)

机构地区：[1]内蒙古医科大学附属医院皮肤科,呼和浩特010010

出　　处：《中华皮肤科杂志》2020年第9期680-684,共5页Chinese Journal of Dermatology

基　　金：国家自然科学基金(81660513);皮肤病学教育部重点实验室开放基金(AY2017-1-009);内蒙古医科大学青年创新基金(YKD2016QNCX031)。

摘　　要：目的总结内蒙古汉族Stevens-Johnson综合征/中毒性表皮坏死松解症(SJS/TEN)患者致敏药物及筛查易感基因。方法内蒙古医科大学附属医院皮肤科2015—2019年确诊的68例汉族SJS/TEN患者,抽取外周血提取DNA,采用PCR筛查HLA-B*5801、HLA-B*1502、HLA-A*3101等位基因。收集患者的临床资料,参照基因分型,分析致敏药物。结果68例SJS/TEN患者,男36例,女32例,年龄46.06±19.97(3~84)岁。检出HLA-B*5801阳性5例,4例为别嘌醇致敏;HLA-B*1502阳性14例,5例为卡马西平、4例为拉莫三嗪致敏,5例致敏/可疑致敏药物为抗菌药物、解热镇痛药等;HLA-A*3101阳性1例,可疑致敏药物为中药活血针剂,成分不清。结论HLA-B*5801对别嘌醇、HLA-B*1502对卡马西平和拉莫三嗪的预测性良好,建议用药前筛查,而HLA-A*3101在本地区人群阳性率不高。Objective To analyze culprit drugs and screen susceptible genes in patients of Han nationality with Stevens-Johnson syndrome(SJS)/toxic epidermal necrolysis(TEN)in Inner Mongolia.Methods A total of 68 patients of Han nationality with confirmed SJS/TEN were collected from Department of Dermatology,the Affiliated Hospital of Inner Mongolia Medical University between 2015 and 2019.DNA was extracted from peripheral blood samples,and PCR was performed to screen HLA-B*5801,HLA-B*1502 and HLA-A*3101 alleles.Clinical data were collected from the patients,and culprit drugs were analyzed according to the genotypes.Results Among the 68 patients with SJS/TEN,there were 36 males and 32 females,aged 46.06±19.97(range,3-84)years.Five cases were positive for HLA-B*5801 allele,of which 4 were induced by allopurinol;14 cases were positive for HLA-B*1502 allele,of which 5 were induced by carbamazepine,4 were induced by lamotrigine,and 5 were induced or likely induced by antibiotics and antipyretic analgesics;only 1 case was positive for HLA-A*3101 allele,and the suspected culprit drug was a traditional Chinese medicine injection for promoting blood circulation with unclear ingredients.Conclusions HLA-B*5801 has a good predictive effect on allopurinol-induced drug eruptions,and HLA-B*1502 on carbamazepine-and lamotrigine-induced drug eruptions.It is recommended to screen susceptible genes before medication.However,the positive rate of HLA-A*3101 was not very high in the population in Inner Mongolia.

关 键 词：STEVENS-JOHNSON综合征 表皮坏死松解症 中毒性 HLA-A抗原 HLA-B抗原 基因型 卡马西平 别嘌呤醇 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]