抗癫痫药物过敏综合症:两个案例报道和文献综述(英文)

抗癫痫药物过敏综合反应(AED)的发生涉及严重的皮肤、血和肝损伤。在严重的情况下,爆发性肝衰竭可能需要肝移植,大多数病人因肝衰竭而死去。严重的皮肤不良反应主要有罕见但致命的:史蒂夫·约翰逊综合症(SJS),中毒性表皮坏死松解症(TEN)和超敏反应综合征等。上述不良反应的致死率高达5%–50%。早期的准确诊断和及时治疗可能降低死亡率。本文报道了两个癫痫患者对卡马西平(CBZ)或苯巴比妥(PB)的过敏综合反应案例,来阐明癫痫的治疗过程和早期表现有助于改善癫痫的治疗方案,同时防止了潜在严重的AED的皮肤不良反应。两个案例报告强调在卡马西平及苯巴比妥的治疗中引起的致命性过敏反应可能与患者肝脏中缺少环氧化物羟化酶及基因缺失有关。

Hypersensitive syndrome reaction of antiepileptic drug: two case reports and literature review

Hypersensitivity syndrome reaction of antiepileptic drug (AED) can induce serious cutaneous, hematological and hepaticevents. In severe cases, fulminant hepatic failure may necessitate liver transplantation, and most patients die due to the liver failure. Severe adverse cutaneous reactions, including Steven-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and hypersensitivity syndrome, are rare but life-threatening. Its morality rate is as high as 5%–50%. Accurate early diagnosis and timely treatment may contribute to decreased morality rate. In this paper, we reported cases of hypersensitive syndrome reaction to carbamazepine (CBZ) or phenobarbital (PB) in two patients with epilepsy. Clarification of the therapeutic process and the early manifestation of epilepsy may be helpful to improve the epilepsy therapy while avoiding the potential severe adverse cutaneous reactions of AED. The two reported cases highlighted that the therapeutic process of CBZ and PB might lead to the fatal allergic reaction, which was mainly caused by the absence of epoxide-hydroxylase and the defect of hepatocytes.