中国麻风皮肤病杂志 ›› 2026, Vol. 42 ›› Issue (2): 106-110.doi: 10.12144/zgmfskin202602106

• 临床研究 • 上一篇    下一篇

40例重症药疹患者临床分析

李智1,刘晓瑛1,李洋1,赵心童1,冯毅慧2,曲才杰1,于海洋1,王昌媛1   

  1. 1青岛市市立医院皮肤科，山东青岛，266011; 2康复大学，山东青岛，266113
  • 出版日期:2026-02-15 发布日期:2026-01-28

Clinical analysis of 40 cases of severe ctaneous adverse reactions

LI Zhi1, LIU Xiaoying1, LI Yang1, ZHAO Xintong1, FENG Yihui2, QU Caijie1, YU Haiyang1, WANG Changyuan1   

  1. 1 Department of Dermatology, Qingdao Municipal Hospital, Qingdao 266011, China; 2 University of Health and Rehabilitation Sciences, Qingdao 266113, China
  • Online:2026-02-15 Published:2026-01-28

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摘要： 目的：回归性分析2019-2023年青岛市市立医院收治的重症药疹患者的临床资料，为重症药疹的合理防治、减少其并发症、提高治愈率提供参考。方法：通过电子病历系统收集2019年7月至2023年12月青岛市市立医院40例住院重症药疹患者的临床资料，分析不同疾病类型患者的临床特征。结果：40例重症药疹中，男15例，女25例，Stevens-Johnson综合征32例，急性泛发性发疹性脓疱病4例，剥脱性皮炎型药疹3例，中毒性表皮坏死松解症1例。患者发热25例，浅表淋巴结肿大3例，36例伴有黏膜受累，肝功能异常10例，高胆红素血症伴黄疸1例，急性肾功能衰竭1例。 停用可疑致敏药物，早期予以足量糖皮质激素治疗，联合TNF-α抑制剂5例，环孢素3例，丙种球蛋白2例，6例痊愈出院，34例好转出院，无死亡病例。36例致敏药物明确，首次用药后发生重症药疹的34例，重复用药发生重症药疹的2例，致敏药物中抗生素15例，中药、中成药12例，解热镇痛药4例，抗肿瘤药物3例，抗癫痫药2例。结论：重症药疹患者临床症状多样，包括红斑、脱屑、大疱和黏膜受累、高热以及脏器功能损害等症状，Stevens-Johnson 综合征最常见，致敏药物以抗生素为主，早期足量系统应用糖皮质激素和丙种球蛋白是治疗重症药疹的关键。

关键词: 重症药疹, Stevens-Johnson综合征, 泛发性发疹性脓疱病, 中毒性表皮坏死松解症, 抗生素

Abstract: Objective: To retrospectively analyze the clinical data of patients with severe ctaneous adverse reactions (SCARs) admitted to Qingdao Municipal Hospital from 2019 to 2023, so as to provide references for rational prevention, reduction of complications, and improvement of cure rates. Methods: Clinical data of 40 inpatients with SCARs admitted to Qingdao Municipal Hospital from July 2019 to December 2023 were collected through the electronic medical record system. The clinical characteristics of patients with different disease types were analyzed. Results: Among the 40 cases of SCARs, there were 15 males and 25 females, including 32 cases of Stevens-Johnson Syndrome (SJS), 4 cases of acute generalized exanthematous pustulosis (AGEP), 3 cases of exfoliative dermatitis (ED), and 1 case of toxic epidermal necrolysis (TEN). 25 patients had fever, 3 had superficial lymphadenopathy, 10 had mucosal involvement, 10 had abnormal liver function , 1 case had hyperbilirubinemia with jaundice, and 1 case had acute renal failure. Suspicious sensitizing drugs were discontinued, and early adequate glucocorticoid therapy was administered. Additionally, 5 cases were treated with TNF-α inhibitors, 3 with cyclosporine, and 2 with intravenous immunoglobulin (IVIG). Six patients were discharged cured, 34 were discharged improved, and there were no deaths. The sensitizing drugs were confirmed in 36 cases: 34 cases occurred after the first drug use, and 2 cases after repeated drug use. Among the sensitizing drugs, 15 were antibiotics, 12 were traditional Chinese medicines (TCMs) and proprietary Chinese medicines, 4 were antipyretic and analgesic drugs, 3 were antitumor drugs, and 2 were antiepileptic drugs. Conclusions: SCARs present diverse clinical manifestations, including erythema, desquamation, blisters, mucosal involvement, high fever, and organ function impairment. SJS is the most common type, and antibiotics are the main sensitizing drugs. Early and adequate systemic application of glucocorticoids and IVIG is the key to the treatment of severe drug eruptions.

Key words: severe cutaneous adverse reactions, SJS, AGEP, TEN, antibiotics