醋甲唑胺致Stevens-Johnson综合征和中毒性表皮坏死松解症的系统评价  

Stevens-Johnson syndrome and toxic epidermal necrolysis induced by methazolamide: a systematic review

作　　者：刘尚可 杨智博 古秋梅 陈正举 陈蕾[2] LIUShangke;YANG Zhibo;GU Qiumei;CHEN Zhengju;CHEN Lei(School of Medicine UESTC,Chengdu 610054,P.R.China;West China Hospital of Sichuan University,Chengdu 610041,P.R.China;Eye School of Chengdu University ofTCM,Chengdu 610075,P.R.China)

机构地区：[1]电子科技大学医学院,成都610054 [2]四川大学华西医院,成都610041 [3]成都中医药大学眼科学院,成都610075

出　　处：《中国循证医学杂志》2022年第3期345-350,共6页Chinese Journal of Evidence-based Medicine

基　　金：四川华西-电子科大交叉合作项目(编号:HXDZ21006)。

摘　　要：目的系统评价醋甲唑胺致Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)和中毒性表皮坏死松解症(toxic epidermal necrolysis,TEN)的临床表现和相关基因分型,为由醋甲唑胺诱导Stevens-Johnson综合征和中毒性表皮坏死松解症的诊治提供思路。方法计算机检索PubMed、EMbase、CNKI和WanFang Data数据库,检索时限均从建库至2021年9月。由2位评价员独立筛选文献、提取资料后,对纳入研究进行系统评价。结果共纳入18个研究,包括49例患者。37例进行了HLA基因检测,其中27例检测出HLA-B*59:01片段,15例检测出HLA-C*01:02片段,同时携带两种基因的有14例患者。合并结果显示HLA-B*59:01的总阳性率为73%[95%CI(58%,88%)];HLA-C*01:02的总阳性率为40.5%[95%CI(24%,57%)]。潜伏时间为14.08±8.77天。醋甲唑胺使用剂量为88.95±39.45 mg/d。糖皮质激素和静脉注射免疫球蛋白是主要的治疗手段。结论使用醋甲唑胺治疗,可能会诱导严重的Stevens-Johnson综合征和中毒性表皮坏死松解症,用药前对HLA-B*59:01和/或HLA-C*01:02基因筛选或许能有效减少醋甲唑胺引起的副作用。应用糖皮质激素、静脉注射免疫球蛋白等治疗有望控制病情。Objective To summarize the genotypes associated with Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)induced by methazolamide and to provide references for the diagnosis and treatment of SJS and TEN induced by methazolamide.Methods Databases including PubMed,EMbase,CNKI,and WanFang Data were electronically searched from database inception to September 2021.Two reviewers independently screened literature and extracted data,and then a systematic review was performed.Results A total of 18 studies involving 49 patients were included.HLA genetic testing was performed on 37 patients.HLA-B*59:01 was detected in 27 patients,HLA-C*01:02 was detected in 15 patients,and 14 patients carried both genes.Statistical analysis showed that the positive rate of HLAB*59:01 was 73%(95%CI 0.58 to 0.88)and that of HLA-C*01:02 was 40.5%(95%CI 0.24 to 0.57).The latent time until the symptoms were observed was 14.08±8.77 days,and the mean dosage of methazolamide administered was 88.95±39.45 mg/d.Glucocorticoid and immunoglobulin were the main treatments prescribed.Conclusion Methazolamide can cause SJS and TEN.As the presence of HLA-B*59:01 or HLA-C*01:02 has been reported as a genetic risk factor for these adverse drug reactions,the implementation of genetic screening can effectively reduce their occurrence.Glucocorticoid and immunoglobulin,anti-infectives,should be administered to control the symptoms.

关 键 词：醋甲唑胺 STEVENS-JOHNSON综合征 中毒性表皮坏死松解症 HLA基因 

分 类 号：R969[医药卫生—药理学]