药疹发病机制及预防诊断相关问题  

The mechanism, prevention and diagnosis of cutaneous adverse drug reaction

作　　者：徐丹丹 关明[2] 骆肖群[1] Xu Dandan;Guan Ming;Luo Xiaoqun(Department of Allergy and Immunology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Clinical Laboratory,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院变态反应科,上海200040 [2]复旦大学附属华山医院检验科,上海200040

出　　处：《中华预防医学杂志》2021年第5期574-582,共9页Chinese Journal of Preventive Medicine

摘　　要：药物不良反应是用药过程中常遇到的且十分困扰临床医生的问题,皮肤是药物不良反应最常累及的器官之一。药物不良反应累及皮肤称之为“药物性皮炎”,即“药疹”,少数情况下甚至会出现累及生命的重症药疹,但由于临床混合用药的情况导致真实的致敏药物难以明确,致使临床治疗中多种药物无法使用。随着基因组学的发展,许多研究发现人类白细胞抗原(human leukocyte antigen,HLA)等位基因和特定药物导致的药疹发病有着密切联系,用药前进行HLA风险基因筛查可显著降低相关药物重症药疹的发病率,但HLA基因筛查仅能预防有限的药物导致的重症药疹,大多数药物尚未发现HLA风险基因位点,因此只能通过其他检查明确致敏药物。目前药物激发试验在国际上被认为是明确致敏药物的“金标准”,但由于此测试方法风险较大并没有得到广泛开展。除此之外,多种体内外检查方法(体内试验包括斑贴试验及药物皮肤试验,体外试验包括血清IgE检测、嗜碱性粒细胞活化试验及淋巴细胞转化试验等)也为明确致敏药物提供依据。Adverse drug reactions are often encountered in the process of medication and are quite troublesome for clinicians.Skin is one of the most frequently affected organs by adverse drug reactions.Adverse drug reactions involving skin are called"drug-induced dermatitis"or"drug eruption".In some rare instances,drug eruption can be severe and life-threatening which is known as severe cutaneous adverse drug reaction.However,due to the mixed use of drugs,it is difficult to identify the culprit drug,which makes multiple drugs needed to be avoided.Recently,many studies have found that HLA alleles are closely related to the certain culprit drug.HLA genotyping before administration can significantly reduce the incidence of severe cutaneous adverse drug reaction related to certain drugs.Since limited HLA alleles are found,HLA genotyping can only prevent adverse drug reaction to a limited extent.At present,drug provocation tests are regarded as the"gold standard"to identify the culprit drug.However,this diagnostic program has not been widely developed because of the high risk.In addition,a variety of in vivo and in vitro diagnostic methods(including drug patch test,drug skin test,drug specific IgE test,basophil activation test,lymphocyte transformation test,et al)also provide evidences to identify the culprit drug.

关 键 词：药物过敏 药疹 人类白细胞抗原 易感基因 致敏药物 药物激发试验 体内试验 体外试验 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]