重症药疹 32例回顾性分析

目的探讨重症药疹的发生发展规律、治疗、临床特点和预后。方法回顾分析山西医科大学第一医院皮肤科 2014年 12月至 2018年 4月间收治的 32例重症药疹( Severe Drug Eruption,SDE)病人相关资料。结果重症多形红斑型药疹是最常见重症药疹类型,共 20例( 62.50%)。潜伏期最长的重症药疹类型是剥脱性皮炎型药疹,为( 22.44±13.97)d。最常见致敏药物为抗癫痫药。发热及黏膜损害发生率最高。激素联合静脉滴注丙种球蛋白治疗重症药疹病人在皮损控制时间( 6.38±1.71)d、素的最大用量( 1.06±0.37)mg·kg-1·d-1、皮损控制时激素累积剂量( 6.62±3.32)mg/kg、激素总累积剂量( 8.40±3.39)mg/kg等方面激均较单用激素组低( P＜0.05)。结论各型重症药疹临床表现各有不同;且易对黏膜、肝肾等造成伤害,威胁到病人生命,临床医师应该谨慎使用易致敏药物,如卡马西平、中药 /中成药、青霉素等;首选治疗方案仍然是静脉滴注糖皮质激素,早期联合丙种球蛋白疗效更佳。     

重症药疹64例临床分析

目的 分析64例重症药疹的致敏药物、治疗方法及预后情况.方法 对本院2001年1月～2011年12月64例重症药疹住院患者的病历资料进行回顾性分析.结果 重症药疹最常见的致敏药是解热镇痛药,其次是抗生素和抗癫痫类.最常见的重症药疹类型为重症多形红斑型,重症药疹的预后与药疹类型、是否并发内脏损害有很大关系.结论 早期足量使用糖皮质激素是重症药疹治疗成功的关键,大剂量糖皮质激素治疗无效时,联合使用大剂量免疫球蛋白是最佳治疗选择.     

重症药疹的临床特点及预后分析

目的：探讨重症药疹的临床特点及影响预后的因素。方法：对37例重症药疹患者的临床资料进行回顾性分析。结果：37例重症药疹中,重症多形红斑型药疹16例,剥脱性皮炎型药疹12例,中毒性表皮坏死松解型药疹9例。在致敏药物中,解热镇痛类药物和镇静催眠抗惊厥药占首位．其他依次为抗生素、别嘌呤醇及其他类药物。结论：重症药疹的预后与患者的年龄、发病到正规足量使用糖皮质激素治疗的时间以及内脏受累的程度有关。早期足量应用糖皮质激素,同时联合应用大剂量静脉注射免疫球蛋白治疗可以快速控制症状。具有良好的疗效。     

丙种球蛋白联合糖皮质激素治疗46例重症药疹的临床分析

目的探讨大剂量静脉注射丙种球蛋白（IVIg）联合糖皮质激素治疗3种重症药疹的临床疗效、不良反应和转归。方法回顾性分析46例3种重症药疹患者应用大剂量IVIg联合糖皮质激素治疗的临床资料。结果IVIg联合糖皮质激素治疗对这46例重症皮肤病总体疗效良好,43例完全治愈,仅1例死亡,2例遗留后遗症,无明显不良反应。结论IVIg联合糖皮质激素是治疗重症药疹的有效手段,可以缩短病程、减少糖皮质激素的用量,提高患者的生存率。     

1 例布洛芬混悬液致儿童重症多形红斑报道并布洛芬严重不良反应文献复习

目的:探讨布洛芬混悬液与重症多形红斑的相关性,为布洛芬的安全使用提供参考。 方法:分析 1 例布洛芬混悬液导致重症多形红斑的病例,并进行文献复习。 结果:根据国家药品不良反应中心药品不良反应/ 事件关联性评价标准,布洛芬混悬液引起重症多形红斑的可能性较大。 查阅文献,布洛芬引起的皮肤不良反应大多为轻型药疹,罕见重型药疹,也有布洛芬引起多形红斑、Stevens-Johnson 综合征、中毒性表皮坏死松解症、剥脱性皮炎、超敏反应综合征等严重皮肤不良反应的个例报道。 结论:布洛芬临床应用广泛,耐受性好,但需警惕其严重皮肤不良反应。     

重症药疹的治疗

重症药疹通常指重症多形红斑型(SJS)、大庖性表皮坏死松解型(TEN)及剥脱性皮炎型(ED)药疹等,是较严重的药物反应,其病情急、病势凶、死亡率高,尤其是TEN型。重症药疹的并发症是影响死亡率的主要因素,应引起高度重视。现将近6年来维普数据库中有关重症药疹冶疗的文章加以综述。1．糖皮质激素的使用目前有些作者对于糖皮质激素治疗SJS和TEN的作用尚有争论,认为糖皮质激素对于本病的生存率并无明显改善,     

丙种球蛋白联合较低剂量糖皮质激素治疗寻常型天疱疮12例疗效观察

目的评价大剂量丙种球蛋白联合较低剂量糖皮质激素治疗寻常型天疱疮的疗效及不良反应.方法寻常型天疱疮患者入院后应用丙种球蛋白每日一次,每次0.4g/kg,静脉滴注,连续5天,同时联合应用较常规低一个档次剂量的糖皮质激素治疗.结果所有患者应用丙种球蛋白联合激素治疗后均取得明显疗效,91.6%的患者2～6天后水疱停止发生,尼氏征转阴,粘膜损害消退,未发现丙种球蛋白的不良反应.结论大剂量丙种球蛋白联合较低剂量糖皮质激素治疗寻常型天疱疮可缩短病程,减少激素的用量,降低激素副作用,是一种临床上值得推广的方法,尤其适用于合并其它内科疾病、不宜大量使用激素的病人.     

小儿药物超敏综合征10例临床分析

目的：探讨小儿药物超敏综合征的临床表现及治疗方法。方法：回顾分析10例药物超敏反应综合征患者的临床资料。结果：10例患者均以发热、皮疹为首发症状,均伴浅表淋巴结肿大及肝功能损害。其中4例因服用卡马西平过敏,3例因解热镇痛剂（退热药）过敏,1例因头孢类药物过敏,2例原因不明。皮损类型为重症多形红斑型（Stevens-Johnson综合征）8例,剥脱性皮炎型2例。均给予静滴甲基泼尼松龙6mg/（kg·d）（分3次）及丙种球蛋白1g/（kg·d）治疗,经积极治疗后9例患者治愈,1例死亡。结论：药物超敏综合征本质上是一种重症药疹,早期联合使用皮质激素及丙种球蛋白可有效控制病情。     

血液灌流联合血液透析治疗重症多形红斑型药物性皮炎1例

目的 观察血液灌流联合血液透析(HP+HD)配合药物治疗重症多形红斑型药物性皮炎的疗效.方法 伴有肾功能受损的重症多形红斑型药物性皮炎患者1例,在大剂量应用糖皮质激素、抗生素等药物治疗的基础上,及时加用HP+HD配合治疗. 结果 伴有肾功能受损的重症多形红斑型药物性皮炎患者肾损害及时得到改善和恢复,各项临床指标迅速好转并完全痊愈. 结论 及时应用HP+HD配合药物治疗,为重症多形红斑型药物性皮炎治疗赢得时机,疗效好.     

重症多形性红斑型药疹患者的护理体会

重症多形红斑型药疹是一种严重的大疱形多形红斑,伴有全身性反应,如畏寒、高热、脓毒血症及眼、鼻、口腔损害,如处理不当其死亡率高达30％,所以要提高对重症药疹的认识、护理及预防。我院2009年收治12例皮损面积达90％以上的重症多形性红斑型药疹患者,经治疗和精心护理痊愈出院,现报告如下。     

Use of intravenous immunoglobulin in toxic epidermal necrolysis and Stevens-Johnson syndrome: our current understanding

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's disease, syndrome) are considered to be part of a spectrum of adverse cutaneous drug reactions with increasing severity and extent of skin detachment, ranging from SJS (less than 10% body surface area skin detachment, 1-5% mortality) to TEN (greater than 30% skin detachment, 25-35% mortality). Both SJS and TEN are characterized morphologically by ongoing apoptotic keratinocyte cell death that results in the separation of the epidermis from the dermis. Recent evidence is supportive of a role for the death receptor Fas and its ligand FasL, in the pathogenesis of keratinocyte apoptosis during TEN. This Fas-mediated keratinocyte apoptosis that causes epidermal detachment in TEN can be inhibited in vitro by antagonistic monoclonal antibodies to Fas and by intravenous immunoglobulins (IVIG) which have been shown to contain natural anti-Fas antibodies. Over the last 6 years, numerous case reports and 8 non-controlled clinical studies containing 9 or more patients have analyzed the therapeutic effect of IVIG in TEN. Taken together, although each study has its potential biases, 6 of the 8 studies point towards a benefit of IVIG used at doses greater than 2 g/kg on the mortality associated with TEN. Hopefully, these studies will serve as the basis for designing a prospective controlled trial in the near future; as such, an approach appears the only way to definitively determine the therapeutic potential of IVIG in TEN.     

临床药师参与左股骨骨折合并MRS感染并发重症多形红斑型药疹的药学监护

目的:临床药师通过参与左股骨骨折后合并甲氧西林耐药的表皮葡萄球菌感染并发重症多形红斑型药疹患者的药物治疗实践,优化选择有利于患者药物治疗的方案。方法:临床药师根据患者的病情变化,提供咨询意见,与临床医师协商,制定针对性的治疗方案,并随时调整。结果:经过1个月的抗感染和激素治疗,终于成功控制患者的感染和严重的不良反应。结论:临床药师参与临床治疗实践,有利于及时发现和处理患者的不良反应,并提高药物治疗水平。     

Possible lenalidomide-induced Stevens-Johnson syndrome during treatment for multiple myeloma

Stevens-Johnson syndrome is a rare, severe cutaneous reaction most often associated with drug therapy. Lenalidomide is a derivative of thalidomide used in the treatment of multiple myeloma. We describe a case of Stevens-Johnson syndrome possibly induced by lenalidomide in a 73-year-old Caucasian female undergoing induction therapy for multiple myeloma. After 13 doses of induction therapy, she was admitted to the hospital directly from her oncologist's office after presenting with a diffuse, bodywide, maculopapular rash with desquamation. She had prominent crusting of her lips, erythematous ulcers on her soft palate that could not be distinguished from petechial hemorrhages, and acute kidney injury (serum creatinine concentration 4.6 mg/dl). She was also febrile and hypotensive. Lenalidomide was discontinued, and the patient was treated with intravenous dexamethasone 10 mg every 6 hours and topical corticosteroids. Over the next week, the patient's condition improved, but she had extensive exfoliation of her rash and pruritus that required antihistamine therapy. By hospital day 9, her rash continued to improve, her pruritus resolved, and she was discharged with a tapering dose of oral prednisone. Lenalidomide was switched to bortezomib for her induction therapy, and the patient did not experience any further cutaneous reactions. The results of a skin biopsy concluded that the findings were consistent with a drug hypersensitivity reaction, suspected to be Stevens-Johnson syndrome. Use of the Naranjo adverse drug reaction probability scale indicated a possible relationship (score of 3) between the patient's development of Stevens-Johnson syndrome and lenalidomide therapy. To our knowledge, no published case reports of severe dermatologic reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, to lenalidomide have been reported. Thus, we believe this to be the first published case report of a patient who developed Stevens-Johnson syndrome while receiving lenalidomide for induction therapy for multiple myeloma. Clinicians should have a heightened awareness of the signs and symptoms of these severe skin reactions if their patients are receiving lenalidomide.     

Concomitant use of lamotrigine and aripiprazole increases risk of Stevens-Johnson syndrome?

Stevens-Johnson syndrome is a severe and potentially life-threatening cutaneous reaction associated with lamotrigine. The incidence of developing Stevens-Johnson syndrome during lamotrigine therapy is low. On the basis of the glutamate and dopamine neuron dysregulation hypothesis in schizophrenia, we propose new strategies for the treatment of schizophrenic patients using a glutamate system stabilizer lamotrigine as an adjunctive treatment for the poor responders of a dopamine system stabilizer, aripiprazole. The finding of Stevens-Johnson syndrome in two cases out of three treated with lamotrigine plus aripiprazole, however, has a much higher index of suspicion and it is correct to warn of its possible raised risk. As lamotrigine is currently licensed for the prophylactic treatment of bipolar depression, many of these patients have psychotic features where it would be considered reasonable to add an antimanic atypical antipsychotic such as aripriprazole. The two case reports raised the question about the possible increased risk of Stevens-Johnson syndrome with the combination therapy.     

噻唑烷二酮类药物治疗2型糖尿病的有效性及安全性

噻唑烷二酮类药物是一类新型的治疗2型糖尿病的药物,通过提高机体对胰岛素的敏感性来达到良好控制血糖的作用.噻唑烷二酮类药物还可以有效地降低2型糖尿病患者血中低密度脂蛋白胆固醇、C-反应蛋白、基质金属蛋白酶-9、纤溶酶原激活物抑制剂-11的水平等,提高高密度脂蛋白胆固醇水平,改善血管内皮功能,减少2型糖尿病患者发生心血管疾病的风险.噻唑烷二酮类药物不良反应发生率低,安全性良好.     

Gliptins: A New Class of Oral Antidiabetic Agents

India has the largest population of patients with type 2 diabetes mellitus. The conventional agents used to treat type 2 diabetes frequently exhibit reduced efficacy over time leading to inadequate glycaemic control and are also associated with adverse effects. Hence, there is a need for alternative therapies that can overcome the limitations associated with conventional antidiabetic agents. This review focuses on Gliptins, which have become a research area of intense focus and present an alternative therapeutic strategy for patients with type 2 diabetes. Gliptins show significant improvements in glycaemic control and are well tolerated, particularly with regard to weight change and hypoglycemia. Hence, gliptins are considered as useful agents for the treatment of type 2 diabetes mellitus.     

糖皮质激素长程应用患者药学干预作用分析

目的：考察长期服用糖皮质激素患者实施药学干预的临床效果。方法：选取肾内科诊治的肾病综合征和狼疮性肾炎的患者,分为对照组125例,观察组128例,两组患者均服用糖皮质激素超过6个月。对照组未实施药学干预,观察组患者实施药学干预。比较两组问卷调查结果。结果：观察组对疾病的认识和用药依从性明显好于对照组（P＜0.01）,观察组患者糖尿病、骨质疏松发生率明显低于对照组（P＜0.01）,观察组疗效较对照组稍有提高,差异无统计学意义（P＞0.05）。结论：对长期使用糖皮质激素患者实施药学干预,可有效提高患者的对疾病的认识和用药依从性,降低药物不良反应发生率,值得临床研究应用。     

Fluconazole-associated Stevens-Johnson syndrome

Fluconazole uncommonly causes Stevens-Johnson syndrome. A young Indian man who developed this adverse effect after his second dose of fluconazole is described. The characteristics of previously reported individuals with fluconazole-associated Stevens-Johnson syndrome and toxic epidermal necrolysis are also summarized: three out of five of the patients were immunocompromised, five out of five were hospitalized, and all had complete resolution of this drug-induced condition.     

First case of mirtazepine-induced Stevens-Johnson syndrome from India

A 28-year-old woman, a known case of systemic lupus erythematosus (SLE), was admitted with mucocutaneous ulceroerosive lesions with blisters and thrombocytopenia after taking antidepressant mirtazepine. Exacerbation of SLE and drug-induced eruption was diagnosed. Clinical and laboratory markers were suggestive of Stevens-Johnson syndrome. This is a rare adverse effect of the newer generation antidepressant mirtazepine.KEY WORDS: Mirtazepine, Stevens-Johnson syndrome, systemic lupus erythematosus     

HLA and pharmacogenetics of drug hypersensitivity

Immunologically mediated drug reactions have been traditionally classified as unpredictable based on the fact that they cannot be predicted strictly on the pharmacological action of the drug. Such adverse drug reactions are associated with considerable morbidity and include severe cutaneous adverse reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis and the drug hypersensitivity syndromes (drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome). Over the last decade there have been many associations between these syndromes and Class I and II HLA alleles of the MHC, which have enriched and driven our knowledge of their immunopathogenesis. Significant translation has also occurred in the case of HLA-B*5701 screening being used to exclude at risk patients from abacavir and prevent abacavir hypersensitivity. The ultimate translation of the knowledge of how drugs interact with HLA would be applicable to preclinical drug screening programs to improve the safety and cost-effectiveness of drug design and development.