75例药物超敏反应综合征的特点及不同诊断标准的再评价  

Characteristics and evaluations of different diagnostic criteria for drug-induced hypersensitivity syndrome:a report of 75 cases

作　　者：孙继敏[1] 夏泉[1] 杨培培[1] 方会慧[1] SUN Jimin;XIA Quan;YANG Peipei;FANG Huihui(Department of Pharmacy,First Affiliated Hospital,Anhui Medical University/GradeⅢPharmaceutical Chemistry Laboratory of State Administration of Traditional Chinese Medicine,Anhui Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院药剂科/国家中医药管理局中药化学三级实验室,安徽合肥230022

出　　处：《中国医院药学杂志》2024年第18期2154-2158,共5页Chinese Journal of Hospital Pharmacy

摘　　要：目的:分析药物超敏反应综合征(drug-induced hypersensitivity syndrome,DIHS)的临床特征并比较在不同的诊断标准下预后的差异,为临床早期诊断及安全、合理用药提供参考。方法:回顾性分析安徽医科大学第一附属医院2017-2021年期间根据RegiSCAR标准诊断为DIHS的住院患者,总结临床特点,并应用J-SCAR标准和RegiSCAR评分,比较患者预后的差异。结果:75例DIHS患者中,致敏药物主要是抗癫痫药物(26例)、别嘌醇(17例)、抗感染药物(16例),潜伏期多在10~30 d(78.7%)。主要临床表现有皮疹(100%)、发热(94.7%)、肝脏损害(96.0%)以及嗜酸性粒细胞升高(49.3%),其中有10例使用别嘌醇的患者HLA-B*58:01基因检测阳性。治疗主要应用糖皮质激素或联合静注人免疫球蛋白,最终70例患者好转,5例死亡。有27例(36.0%)符合J-SCAR标准非典型的DIHS,63例(84.0%)符合RegiSCAR评分可能/很可能DIHS。患者RegiSCAR评分≥3分病死率明显高于<3分(P<0.05)。结论:DIHS病情重、易反复、死亡率高,有可疑用药史时,建议尽早进行RegiSCAR评分,及时发现危重症患者,降低病死率。OBJECTIVE To explore the clinical characteristics of drug-induced hypersensitivity syndrome(DIHS) and compare differential outcomes through various diagnostic criteria to provide references for early clinical diagnosis and safe and rational drug dosing.METHODS From 2017 to 2021,the relevant clinical data were retrospectively reviewed for 75 hospitalized DIHS patients according to the RegiSCAR criteria.J-SCAR criteria and RegiSCAR scoring system were utilized for comparing the differential outcomes.RESULTS Among them,the major sensitizing drugs were antiepileptic agents(n=26),allopurinol(n=17) and antibiotics(n=16).The incubation period was(10-30) day(78.7%).The major clinical manifestations were rash(100.0%),fever(94.7%),liver injury(96.0%) and eosinophilia(49.3%).Ten patients on allopurinol tested positive for HLA-B* 58:01 gene.Treatment was offered with glucocorticoids or plus intravenous immunoglobulin.Finally 70 patients improved while another 5 died.Twenty-seven patients(36.0%) fit the J-SCAR criteria for atypical DIHS and 63 patients(84.0%) met the RegiSCAR scoring system for probable/possible DIHS.The mortality rate of patients with RegiSCAR score ≥3 was significantly higher than that of those with RegiSCAR score <3(P<0.05).CONCLUSION DIHS is severe and recurrent with a high mortality rate.Whenever there is a history of suspicious drug dosing,RegiSCAR scoring system may be utilized for identifying critically ill patients timely and lowering mortality.

关 键 词：药物超敏反应综合征 药源性疾病 别嘌醇 RegiSCAR评分 

分 类 号：R969[医药卫生—药理学]