重症药疹41例临床剖析.docVIP

重症药疹41例临床剖析 　　[摘要] 目的 探讨重症药疹的发生规律、临床特点和治疗措施。 方法 对2009年1月～2014年12月广东省人民医院皮肤科收治的41例重症药疹患者的发病年龄、疹型、致敏药物、潜伏期、住院时间和糖皮质激素使用剂量等临床资料进行回顾性分析。 结果 重症药疹中以重症多形红斑型药疹最多见（63.41%），其次是中毒性表皮坏死松解型药疹（26.83%），剥脱性皮炎型药疹排第3位（9.76%），其中以剥脱性皮炎型药疹的潜伏期最长，各型重症药疹的发病年龄、住院时间和使用糖皮质激素剂量比较差异无统计学意义（P 0.05）；抗痛风药别嘌醇在致敏药物中居首位（51.22%），其次是抗癫痫药卡马西平（24.39%）。 结论 不同类型重症药疹的临床表现各异，内脏器官损伤发生率高，与疾病转归有关；临床上应谨慎使用别嘌醇、卡马西平等高发致敏药物；早期足量使用糖皮质激素并联合静脉用人免疫球蛋白治疗可以取得较好的临床效果。 　　[关键词] 重症药疹；临床分析；别嘌醇 　　[中图分类号] R758.25 [文献标识码] A [文章编号] 1673-7210（2016）04（b）-0134-04 　　[Abstract] Objective To investigate the occurrence regularity， clinical feature and treatment of severe drug eruption. Methods 41 severe drug eruption inpatients in the Department of Dermatology of Guangdong General Hospital from January 2009 to December 2014 were selected. Age， eruptive form， allergic drug， incubation period， hospitalization time and corticosteroid dosage were studied. Results Steven-Johnson syndrome was the most common severe drug eruption （63.41%）， next was toxic epidermal necrolysis （26.83%） and exfoliative dermatitis （9.76%）. Exfoliative dermatitis had the longest latent period. There were no significant differences among the different severe drug eruptions of ages， hospitalization time and corticosteroid dosage （P 0.05）. Allopurinol （51.22%） and carbamazepine （24.39%） were the most common causative drugs. Conclusion There were various clinical manifestations with different types of severe drug eruptions， the high incidence of organ damage which is related to the prognosis of the disease. The indication of using allopurinol and carbamazepine should be weighed further. The curative effect may be better after early and sufficiently using corticosteroid combined with intravenous immune globulin. 　　[Key words] Severe drug eruption； Clinical analysis； Allopurinol 　　药疹是皮肤科常见病之一，根据临床表现可分为荨麻疹及血管性水肿型、猩红热样或麻疹样发疹型、固定性药疹等多种类型。传统意义上的重症药疹包括重症多形红斑型（Steven-Johnson syndrome，SJS）、中毒性表皮坏死松解型（toxic epidermal necrolysis，TEN）和剥脱性皮炎型（exfoliative dermatitis，ED）药疹，因