中国麻风皮肤病杂志 ›› 2025, Vol. 41 ›› Issue (11): 801-805.doi: 10.12144/zgmfskin202511801

• 临床研究 • 上一篇    下一篇

58例儿童药物超敏反应综合征临床特征分析

唐鲜艳,李丹,薛秀红,赵芮,李小青   

  1. 西安市儿童医院，陕西西安，710003
  • 出版日期:2025-11-15 发布日期:2025-11-11

Analysis of clinical characteristics of drug-induced hypersensitivity syndrome in 58 children

TANG Xianyan, LI Dan, XUE Xiuhong, ZHAO Rui, LI Xiaoqing   

  1. Xi'an Children's Hospital, Xi'an 710003, China
  • Online:2025-11-15 Published:2025-11-11

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摘要： 目的：分析儿童药物超敏反应综合征（DIHS）的临床特点，提高临床医生对该病的认识。方法：以2016年1月至2023年12月西安市儿童医院收治的58例DIHS患儿为研究对象，对患儿临床特征、辅助检查、治疗决策及预后资料进行回顾和描述性分析。结果：58例DIHS患儿中男30例，女28例，平均年龄2.04（1.00，4.29）岁，其中36例用药史明确，22例为混合用药。致敏药物明确者中最常见诱发药物前三位为抗癫痫药物（20例，34.5%）、抗生素（9例，15.5%）及解热镇痛药（4例，6.9%）。30例DIHS平均潜伏期（20.84±8.09）天。临床表现除有发热及皮疹外，伴有淋巴结肿大43例（74.1%），转氨酶升高53例（91.4%），心肌损害46例（79.3%），肺部损害23例（39.7%）。53例（91.4%）白细胞计数大于11×109/L，39例（67.2%）异常淋巴细胞百分率大于5%，36例（62.1%）嗜酸性粒细胞计数升高。并发嗜血细胞综合征者7例（12.1%）。治疗上积极给予静脉糖皮质激素或/和静注人免疫球蛋白，重者联合血液净化及免疫抑制剂。58例患者平均住院时间（17.67±10.05）天，临床治愈32例（55.2%），好转24例（34.5%），死亡2例（3.4%）。结论：对于反复发热、皮疹、淋巴结肿大、常规治疗效果不佳者，需详细询问近2个月用药史，警惕DIHS。

关键词: 儿童, 药物超敏反应综合征, 多脏器功能损害, 临床特征

Abstract: Objective: To analyze the clinical characteristics of drug-induced hypersensitivity syndrome (DIHS) in children and to enhance clinicians' understanding of this condition. Methods: A retrospective descriptive analysis was conducted on the clinical features, auxiliary examinations, treatment decisions, and prognosis of 58 children with DIHS admitted to Xi'an Children's Hospital from January 2016 to December 2023. Results: Among the 58 children with DIHS, 30 were male and 28 were female, with a median age of 2.04 (IQR: 1.00, 4.29) years. A clear medication history was identified in 36 cases, while 22 cases involved mixed medication use. Among the cases with identified sensitizing drugs, the top three most common triggering drugs were antiepileptic drugs (20 cases, 34.5%), antibiotics (9 cases, 15.5%), and antipyretics/analgesics (4 cases, 6.9%). The mean latency period for DIHS was (20.84 ± 8.09) days in 30 cases. In addition to fever and rash, clinical manifestations included lymphadenopathy in 43 cases (74.1%), elevated transaminases in 53 cases (91.4%), myocardial injury in 46 cases (79.3%), and pulmonary involvement in 23 cases (39.7%). Leukocyte count exceeded 11×109/L in 53 cases (91.4%), atypical lymphocytes exceeded 5% in 39 cases (67.2%), and eosinophil count was elevated in 36 cases (62.1%). Seven cases (12.1%) were complicated by hemophagocytic syndrome. Active treatment involving intravenous glucocorticoids and/or intravenous immunoglobulin was administered, with severe cases additionally receiving blood purification and immunosuppressants. The mean hospital stay for the 58 patients was (17.67 ± 10.05) days. Clinical cure was achieved in 32 cases (55.2%), improvement in 24 cases (34.5%), and death occurred in 2 cases (3.4%). Conclusions: For cases presenting with recurrent fever, rash, lymphadenopathy, and poor response to conventional treatment, a detailed medication history within the past two months should be obtained to alert for the possibility of DIHS.

Key words: children, drug hypersensitivity syndrome, multiple organ dysfunction, clinical features