万古霉素相关血管炎文献病例分析  

Literature case analysis of vancomycin-associated vasculitis

作　　者：王珺 邹东娜 张文 侯宁 WANG Jun;ZOU Dong-na;ZHANG Wen;HOU Ning(Department of Pharmacy,Affiliated Shandong Provincial Hospital,Shandong First Medical University,Shandong Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院药学部,山东济南250021

出　　处：《中国医院药学杂志》2021年第22期2353-2358,共6页Chinese Journal of Hospital Pharmacy

基　　金：山东省医药卫生科技发展计划项目(编号:2019WS501);山东省医学会临床药学科研专项资金(编号:YXH2021ZX008)。

摘　　要：目的:分析万古霉素相关血管炎不良反应发生情况及其临床特点,为临床安全用药提供参考。方法:检索PubMed、Web of Science、Embase、EBSCO、Scopus、ScienceDirect数据库(检索时间为自建库至2021年4月),收集万古霉素相关血管炎的病例报道并进行汇总分析。结果:共收集到万古霉素相关血管炎患者14例,其中男性10例(71.4%),女性4例(28.6%);所有患者中年龄最小的17岁,最大的83岁,中位年龄56.6岁。万古霉素暴露至发生血管炎的时间为1~27 d,多发生在7~15 d(9例)。14例患者均出现皮肤病变,表现为紫癜和(或)皮疹,其中累及四肢4例、下肢7例。13例进行了病变部位皮肤活检,12例示白细胞碎裂性血管炎,1例示狼疮样综合征。诊断血管炎后,14例患者均停用万古霉素,其中11例换用其他抗感染药物,4例接受糖皮质激素治疗,1例局部使用类固醇,14例患者均痊愈。结论:万古霉素相关血管炎多发生在用药后7~15 d,以男性患者居多,主要临床表现为紫癜和皮疹,多累及下肢,症状严重程度不同,及时停药均预后良好。OBJECTIVE To explore the occurrences and clinical characteristics of vancomycin-associated vasculitis and provide references for clinical application.METHODS Case reports of vancomycin-associated vasculitis were searched from the databases of PubMed, Web of Science, Embase, EBSCO,Scopus and ScienceDirect(search time up to April 2021).RESULTS A total of 14 patients were collected, including 10 males(71.4%)and 4 females(28.6%).The median age was 56.6(17-83)years.Time from vancomycin dosing to the occurrence of vasculitis was 1-27 days.It was 7-15 days in 9 patients.There was an onset of purpura and/or rash.Skin lesions involved upper/lower(n=4)and lower extremities(n=7).And 13 patients underwent skin biopsy at lesion site.There were leukocytoclastic vasculitis(n=12)and lupus erythmatosus-like(n=1).Vancomycin was withdrawn after a definite diagnosis of vasculitis.Other antibiotics(n=11),glucocorticoids(n=4)and topical steroids(n=1)were prescribed.Finally all cases were cured.CONCLUSION Vancomycin-associated vasculitis usually occurs predominantly in males at Day 7-15 after an initial medication.Purpura and rash often appears at lower extremities.The severity of symptoms varies and the prognosis is decent when vancomycin is withdrawn timely.

关 键 词：万古霉素 血管炎 白细胞碎裂性血管炎 IgA血管炎 

分 类 号：R969[医药卫生—药理学]