27例来氟米特致重症药疹文献病例分析  

Literature Review of Leflunomide-induced Severe Drug Eruption Cases

作　　者：杨春兰[1] 王康[2] 汪燕燕[1] 夏泉[1] 许杜娟[1] Yang Chunlan;Wang Kang;Wang Yanyan;Xia Quan;Xu Dujuan(Pharmacy Department,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Rheumatism and Immunology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院药剂科,合肥230022 [2]安徽医科大学第一附属医院风湿免疫科,合肥230022

出　　处：《药物流行病学杂志》2021年第4期283-288,共6页Chinese Journal of Pharmacoepidemiology

基　　金：国家自然科学基金青年科学基金项目(编号:8180090607)。

摘　　要：目的:探讨来氟米特导致重症药疹的发生特点,为临床安全用药提供参考。方法:检索建库至2019年12月的VIP、CNKI、WanFang Data和PubMed数据库,筛选后获得来氟米特致重症药疹病例报道相关文献。对纳入病例的患者性别、年龄、原患疾病,给药剂量、发病时间、药疹类型、累及脏器、治疗与转归等进行统计分析。结果:共检索到20篇文献27例重症药疹患者,其中女20例,男7例;平均年龄(40.33±16.60)岁。药疹类型包括中毒性表皮坏死松解7例,多形红斑6例,剥脱性皮炎4例,伴嗜酸性粒细胞增多和系统症状的药疹(DRESS)综合征3例,其他7例。重症药疹发病中位时间21 d。22例患者经治疗后好转,3例出现腹泻和肝功能损害最终死亡,死亡率达11.1%,1例失访,1例因点状结膜炎失明。结论:来氟米特导致重症药疹是较为严重的罕见不良反应,腹泻伴发肝功能损害是导致死亡的高危因素,临床应用时应提高警惕。Objective:To explore the general patterns and characteristics of severe drug eruption caused by leflunomide, in order to provide a reference for clinical safe medication. Methods:Relevant literature reports in the VIP, CNKI, WanFang Data and PubMed databases were searched from domestic and foreign literature databases until December 2019. And after screening with the inclusion criteria, the gender, age, primary disease, leflunomide dose, onset time, type of drug eruption, main therapeutic drugs and outcome of the included cases were analyzed. Results:A total of 20 literatures were retrieved which included 27 cases, they were 20 females and 7 males. The mean age was(40.33±16.60) years. The type of drug eruption was 7 cases of toxic epidermal necrolysis, 6 cases of erythema multiforme, 4 cases of exfoliative dermatitis, 3 cases of DRESS syndrome, and 7 others. The median time to onset of severe drug eruption was 21 days. 22 cases improved after treatment, 3 cases developed diarrhea and liver function damage and eventually died, accounting for 11.1%, 1 case was lost to follow-up, 1 case was blind due to punctate conjunctivitis. Conclusion:Severe drug eruption caused by leflunomide is a more serious rare adverse reaction, accompanied by diarrhea and liver damage is a high risk factor for death. These findings suggest clinicians to monitor patient skin symptoms seriously.

关 键 词：来氟米特 重症药疹 药品不良反应 病例报道 文献综述 

分 类 号：R979[医药卫生—药品]