1883例住院药疹患者致敏药物分析

摘要

Objective To analyze the causative drugs of drug eruptions, basing on the data of a hos-pitalized population from Department of Dermatology, Huashan Hospital during past 10 years. Methods Clinical records of patients with diagnosis of drug eruption were collected and analyze retrospectively, who were admitted into inpatients ward of Department of Dermatology, Huashan Hospital since January 2007 to December 2016. Results A total of 1883 [ male: 652, ( 34. 63%) , female 1231 ( 65. 37%) ] pa-tients were enroll in this study. The most common types of drug eruptions were urticaria (27. 19%), mac-ulopapular exanthema (MPE, 24. 69%), erythema multiforme (EM) -like eruptions (22. 04%), fol-lowed by three kinds of severe types including Stevens-Johnson syndrome ( SJS, 12. 16%) , drug reaction with eosinophils and systemic syndrome ( DRESS, 4. 30%) and toxic epidermal necrolysis ( TEN, 4. 25%) . 53. 43% patients were diagnosed as multiple drugs induced drug eruptions and 45. 83% as single drug induced drug eruptions. The top five most common causative drugs for single drug induced drug eruptions were antibiotics ( 28. 85%) , Traditional Chinese medicine ( TCM, 15. 99%) , antiepileptic agents (13. 56%), anti-hyperuricemia agents (12. 86%) and antipyretic/analgesic agents (9. 15%). The top five most common causative drugs for single drug induced severe drug eruptions were antiepileptic agents ( 36. 15%) , anti-hyperuricemia agents ( 31. 46%) , antibiotics ( 7. 98%) , TCM ( 5. 63%) and antipyretic/analgesic agents ( 5. 63%) . There was one kind of antibiotics and at least two kinds of antibi-otics in suspected causative drugs in 36. 18% and 31. 41% patients with multiple drugs induced drug eruptions respectively. 37. 97% patients with multiple drugs induced drug eruptions were prescribed at least one kind of TCM within the latency period. Conclusion The top two kinds of most common causa-tive drugs for drug eruptions were antibiotics and TCM. The number of TCM induced drug eruptions in-creased remarkably during the recent years. TCM induced drug eruptions should be vigilant.%目的 分析近10年华山医院住院药疹患者的致敏药物谱.方法 对2007年1月1日至2016年12月31日在华山医院住院且确诊为药疹的患者临床资料进行回顾性统计分析.结果 共收集药疹患者1883例,其中男性652例(34.63%),女性1231例(65.37%).最常见的疹型为荨麻疹型药疹(27.19%),其次为斑丘疹型药疹(maculopapular exanthems,MPE)(24.69%)、 多形红斑型药疹(22.04%)、Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)(12.16%)、 药物反应伴嗜酸性粒细胞增多和系统症状(drug reactions with eosinophilia and systemic symptoms,DRESS)(4.30%)、 中毒性表皮坏死松解症(toxic epidermal necrolysis,TEN)(4.25%).混合药物所致药疹占总药疹数的53.43%,余45.83%为单药致敏药疹.单药致敏最常见的五类药物依次为抗生素(28.85%)、 中药及中成药(traditional Chinese medicine,TCM)(15.99%)、 抗癫痫药(13.56%)、 降尿酸药(12.86%)、 解热镇痛药(9.15%);单药致敏重症药疹中前五位最常见的致敏药物种类依次为抗癫痫药(36.15%)、 降尿酸药(31.46%)、 抗生素(7.98%)、TCM(5.63%)、 解热镇痛药(5.63%).36.18%混合用药患者的可疑致敏药物包含1种抗生素;31.41%患者的可疑致敏药物包含2种或2种以上抗生素;37.97%的混合致敏药物药疹患者在潜伏期内至少含1味中药或1种中成药的用药史.结论 抗生素、TCM为药疹最多见的两类致敏药物;由TCM所致的药疹近年来有增多趋势,临床医师在使用时需警惕并预防其相关不良反应的发生.