中国麻风皮肤病杂志 ›› 2023, Vol. 39 ›› Issue (5): 332-337.doi: 10.12144/zgmfskin202305332

• 论著 • 上一篇    下一篇

65例重症药物不良反应患者临床分析

李红慧1,2,赵晴2,尤家宝2,杨宝琦2,杨青2,施仲香1，2,刘红2,张福仁2   

  1. 1山东大学，山东济南，250012;
    2山东第一医科大学附属皮肤病医院（山东省皮肤病医院），山东省皮肤病性病防治研究所，山东济南，250022
  • 出版日期:2023-05-15 发布日期:2023-05-16

Clinical analysis of 65 patients with severe adverse drug reactions

LI Honghui1,2, ZHAO Qing2, YOU Jiabao2, YANG Baoqi2, YANG Qing2, SHI Zhongxiang1,2, LIU Hong2, ZHANG Furen2   

  1. 1 Shandong University, Jinan 250012, China;
    2 Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250022, China
  • Online:2023-05-15 Published:2023-05-16

PDF (PC)

59

摘要： 回顾性分析我院2018年1月1日至2021年12月31日重症药物不良反应患者的临床资料，总结我院住院重症药物不良反应患者的临床特点、治疗及转归。结果示65例重症药物不良反应患者包括DRESS 15例，TEN 12例，SJS 7例，AGEP 23例，ED 8例，平均年龄(48.2±16.8)岁，男女比例0.38∶1，患者从应用致敏药物到发病平均潜伏期(13.5±14.4)天；致敏药物以抗感染药物（30.7%）及中成药（20.0%）为主；肝功能损害是最常见的伴随症状。31例患者采用单用糖皮质激素的常规治疗方案（组1）；11例患者单用糖皮质激素疗效不佳或不能耐受激素副作用，给予糖皮质激素联合TNF-α拮抗剂治（组2）；9例患者病情进展快速，症状严重，给予糖皮质激素联合TNF-α拮抗剂及静脉滴注免疫球蛋白治疗（组3）；组4、组5各7例，病情相对较轻，分别给予单用TNF-α拮抗剂和环孢素治疗。组3患者皮损控制时间（7.4±1.3）天及平均住院时间（15.6±2.6）天分别低于组2的（9.5±2.6）天和（18.1±5.5）天（P<0.05），所有患者皮损控制平均时间(8.8±3.0)天，平均住院时间(16.8±4.4)天。患者出院半年后随访，58例患者痊愈，平均用药时间为(64.7±53.7)天， 3例患者再次住院治疗，2例失访，2例患者死亡。

关键词: 重症药物不良反应, 糖皮质激素, TNF-α拮抗剂, IVIG

Abstract: The clinical data of patients with severe adverse drug reactions in our hospital from January 1, 2018 to December 31, 2021 were analyzed to summarize the clinical characteristics, treatment and regression of severe adverse drug reactions.  A total of 65 patients including 15 of DRESS, 12 of TEN, 7 of SJS, 23 of AGEP and 8 of ED  were analyzed. The mean age of was 48.2±16.8 years, with a male to female ratio of 0.38∶1. The mean incubation period from the application of allergenic drugs to the onset of disease was 13.5±14.4 days. The allergenic drugs were mainly anti-infective drugs (30.7%) and proprietary Chinese medicines (20.0%). The liver function impairment was the most common concomitant symptom. Patients were divided into five groups:  31 patients in group 1 were treated with the conventional regimen of glucocorticoids alone. 11 patients in group 2 were given glucocorticoids combined with TNF-α antagonists due to poor efficacy of glucocorticoids alone or intolerance of hormonal side effects. 9 patients in group 3 who had rapid progression and severe symptoms were treated with glucocorticoids combined with TNF-α antagonists and intravenous immunoglobulin. 14 patients with relatively mild manifestation were treated with TNF-α antagonist （7 patients）or cyclosporine alone (7 patients). The average duration of skin lesion control for all patients was 8.8±3.0 days and the average length of stay was 16.8±4.4 days. The mean time to lesion control (7.4±1.3 days) and mean hospital stay (15.6±2.6 days) were lower in group 3 than in group 2 (9.5±2.6 days) and (18.1±5.5 days) (P<0.05). Follow-up 6 months after discharge, 58 patients cured and, the average duration of medication was 64.7±53.7 days, 3 cases received another hospitalization for recurrence, 2 died, 2 loss to follow-up.

Key words: severe adverse drug reactions, glucocorticoids, tumour necrosis factor antagonists, intravenous immunoglobulin