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Article(id=1322930552327766863, tenantId=1146029695717560320, journalId=1322258570227581120, issueId=1322930551082066821, articleNumber=null, orderNo=null, doi=10.12435/j.issn.2095-5227.25111104, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1762790400000, receivedDateStr=2025-11-11, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340822536, onlineDateStr=2026-10-30, pubDate=1782576000000, pubDateStr=2026-06-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340822536, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340822536, creator=13701087609, updateTime=1793340822536, updator=13701087609, issue=Issue{id=1322930551082066821, tenantId=1146029695717560320, journalId=1322258570227581120, year='2026', volume='47', issue='6', pageStart='608', pageEnd='678', issueExtLink='null', onlineDate='null', pubDate='1782576000000', pubDateStr='2026-06-28', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340822239, creator='13701087609', updateTime=1793344296949, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322945125147607535, tenantId=1146029695717560320, journalId=1322258570227581120, issueId=1322930551082066821, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322945125147607536, tenantId=1146029695717560320, journalId=1322258570227581120, issueId=1322930551082066821, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=653, endPage=658, ext={EN=ArticleExt(id=1322930552600396625, articleId=1322930552327766863, tenantId=1146029695717560320, journalId=1322258570227581120, language=EN, title=A single-center analysis of clinical characteristics and prognosis of drug-induced hypersensitivity syndrome in adults, columnId=1322930552503927632, journalTitle=Academic Journal of Chinese PLA Medical School, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=
Background

Drug-induced hypersensitivity syndrome (DIHS) is a severe, potentially life-threatening adverse drug reaction marked by a prolonged latency period and frequent relapses, posing significant challenges for early clinical recognition.

Objective

To analyze the clinical characteristics, distribution of culprit drugs, laboratory abnormalities, and prognostic factors in patients with drug-induced hypersensitivity syndrome (DIHS), so as to provide evidence for early clinical identification and treatment.

Methods

Clinical data were collected from patients with DIHS who were hospitalized in the Department of Dermatology, the First Medical Center of PLA General Hospital from January 2015 to December 2025. Patients with a RegiSCAR score ＞5 were defined as confirmed cases. The demographic characteristics, culprit drugs, clinical manifestations, laboratory findings, treatment, and outcomes of the patients were analyzed.

Results

A total of 34 patients diagnosed with DIHS were enrolled in this study, including 16 males and 18 females, with a mean age of (43.6±16.5) years. Most patients (76.5%) were aged between 30 and 55 years. The incubation period of the disease ranged from 2 to 60 days, with a median of 21 (IQR: 11 - 30) d. In terms of clinical manifestations, aside from skin rash, liver function impairment had an extremely high incidence (28 cases, 82.4%). The main causative sensitizing drugs included antibacterial agents (12 cases, 35.3%), traditional Chinese medicine (7 cases, 20.6%), anti-gout drugs (5 cases, 14.7%), and anti-epileptic drugs (4 cases, 11.8%), antipyretic and analgesic agents in 2 cases (5.9%),antidepressant medications in 2 cases (5.9%),additionally, 1 case was induced by an immunosuppressant and 1 case by a biological agent. Laboratory examinations revealed leukocytosis in 24 cases (70.6%) and eosinophilia in 17 cases (50.0%). Concomitant viral or pathogen infections were detected as follows: cytomegalovirus infection in 14 cases (41.2%), herpes simplex virus infection in 12 cases (35.3%), Epstein-Barr virus positive infection in 11 cases (32.4%), rubella virus positive infection in 9 cases (26.5%), Coxsackievirus positive in 1 case (2.9%), and mycoplasma pneumoniae positive in 4 cases (11.8%). All patients received glucocorticoid therapy, and nearly half (16 cases, 47.1%) received combined treatment with intravenous immunoglobulin. All 34 patients achieved short-term clinical remission after treatment, with an overall response rate of 100%; during long-term follow-up, 27 cases (79.4%) were cured and 7 cases (20.6%) experienced recurrence. The incubation period of the recurrence group was significantly longer than that of the non-recurrence group ([34.9±19.0] d vs [20.2±11.4] d, P=0.015).

Conclusion

DIHS cases in our center are characterized by a relatively long latency period. Antibacterials and traditional Chinese herbal medicines are the predominant culprit drugs, and liver function impairment is common. Early recognition, prompt withdrawal of the offending drug, and administration of systemic corticosteroids yield definite therapeutic efficacy. Viral infections may be associated with disease relapse, although the value of antiviral therapy remains to be validated.

, authors=Wenwei ZHU, Cuihao SONG, Lin SHEN, Lichuan TANG, Yong ZHOU, authorsList=Wenwei ZHU, Cuihao SONG, Lin SHEN, Lichuan TANG, Yong ZHOU, authorCompany=null, correspAuthors=Yong ZHOU, authorNote=null, correspAuthorsNote=
ZHOU Yong. Email:
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背景

药物超敏反应综合征(drug-induced hypersensitivity syndrome，DIHS)是一种严重且可能致命的药物不良反应，具有潜伏期长、易复发的特点，临床早期识别困难。

目的

分析DIHS患者的临床特征、致敏药物分布、实验室检查异常及预后相关因素，为临床早期识别和治疗提供依据。

方法

收集2015年1月至2025年12月于解放军总医院第一医学中心皮肤科住院治疗的DIHS患者临床资料。根据RegiSCAR评分系统将评分＞5分的患者定义为确诊病例。分析患者的人口学特征、致敏药物、临床表现、实验室检查、治疗及转归。

结果

共纳入34例 DIHS患者，男16例，女18例，平均年龄(43.6±16.5)岁，大部分患者(76.5%)集中在(30 ~ 55)岁。患病潜伏期(2 ~ 60) d，中位数为21(IQR：11 ~ 30) d。临床表现上除皮疹外，肝功能损害发生率极高(28例，82.4%)。主要致敏药物包括抗菌药12例(35.3%)、中药7例(20.6%)、抗痛风药5例(14.7%)、抗癫痫药4例(11.8%)，解热镇痛药2例(5.9%)、抗抑郁药2例(5.9%)，但也有免疫抑制剂1例和生物制剂1例。实验室检查显示白细胞升高24例(70.6%)，嗜酸性粒细胞增多17例(50.0%)；伴巨细胞病毒感染14例(41.2%)，单纯疱疹病毒感染12例(35.3%)、EB病毒阳性感染11例(32.4%)、风疹病毒阳性9例(26.5%)、柯萨奇病毒阳性1例(2.9%)、肺炎支原体阳性4例(11.8%)。所有患者均接受糖皮质激素治疗，近半数(16例，47.1%)联合静脉用丙种球蛋白。34例患者治疗后近期均达临床缓解，总有效率100%；远期随访中27例治愈(79.4%)，7例复发(20.6%)。复发组潜伏期显著长于非复发组[(34.9±19.0) d vs (20.2±11.4) d，P=0.015]。

结论

本研究DIHS病例呈现出潜伏期较长的特点，抗菌药和中药是主要致敏药物，肝功能损害常见。早期识别、及时停用致敏药物并给予糖皮质激素治疗疗效确切。病毒感染可能与复发相关，但抗病毒治疗价值尚需验证。

, authors=朱文巍, 宋翠豪, 申琳, 汤丽川, 周勇, authorsList=朱文巍, 宋翠豪, 申琳, 汤丽川, 周勇, authorCompany=null, correspAuthors=周勇, authorNote=

朱文巍：论文撰写；宋翠豪：审读和修订；周勇：监督指导；申琳，汤丽川：审读和修订。

朱文巍，硕士，主治医师。Email:

, correspAuthorsNote=
周勇，博士，副主任医师。Email:
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articleId=1322930552327766863, language=CN, orderNo=3, keyword=临床特征), Keyword(id=1322930557096690552, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, orderNo=4, keyword=致敏药物), Keyword(id=1322930557201548153, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, orderNo=5, keyword=预后)], refs=[Reference(id=1322930560120783749, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2025, volume=18, issue=null, pageStart=655, pageEnd=664, url=null, language=null, rfNumber=1, rfOrder=0, authorNames=Zhang HY, Jiang P, Mei SB, journalName=J Asthma Allergy, refType=null, unstructuredReference=Zhang HY，Jiang P，Mei SB，et al. 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BMC Pulm Med，2021，21（1）：350., articleTitle=Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate, refAbstract=null), Reference(id=1322930561760756631, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2022, volume=10, issue=5, pageStart=1155, pageEnd=1167, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=Hama N, Abe R, Gibson A, journalName=J Allergy Clin Immunol Pract, refType=null, unstructuredReference=Hama N，Abe R，Gibson A，et al. Drug-induced hypersensitivity syndrome （DIHS）/drug reaction with eosinophilia and systemic symptoms （DRESS）： clinical features and pathogenesis［J］. 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Clin Dermatol，2020，38（6）：702-711., articleTitle=Drug reaction with eosinophilia and systemic symptoms （DRESS） syndrome, refAbstract=null), Reference(id=1322930562440233882, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2022, volume=314, issue=8, pageStart=721, pageEnd=728, url=null, language=null, rfNumber=21, rfOrder=20, authorNames=Sharma AN, Shwe S, Ravi V, journalName=Arch Dermatol Res, refType=null, unstructuredReference=Sharma AN，Shwe S，Ravi V，et al. Characterizing DRESS syndrome recurrence： a systematic review［J］. Arch Dermatol Res，2022，314（8）：721-728., articleTitle=Characterizing DRESS syndrome recurrence： a systematic review, refAbstract=null), Reference(id=1322930562503148443, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2024, volume=43, issue=7, pageStart=1139, pageEnd=1144, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=郑伟, 莫小兰, 汪雪莲, journalName=医药导报, refType=null, unstructuredReference=郑伟，莫小兰，汪雪莲，等. 12例伴疱疹病毒再激活的儿童药物超敏反应综合征回顾性分析［J］. 医药导报，2024，43（7）：1139-1144., articleTitle=12例伴疱疹病毒再激活的儿童药物超敏反应综合征回顾性分析, refAbstract=null), Reference(id=1322930562578645916, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2025, volume=32, issue=3, pageStart=206, pageEnd=210, url=null, language=null, rfNumber=23, rfOrder=22, authorNames=包凌云, 刘雯敏, 聂小娟, journalName=皮肤性病诊疗学杂志, refType=null, unstructuredReference=包凌云，刘雯敏，聂小娟，等. 环孢菌素A联合糖皮质激素成功治疗反复发作的药物超敏反应综合征1例［J］. 皮肤性病诊疗学杂志，2025，32（3）：206-210., articleTitle=环孢菌素A联合糖皮质激素成功治疗反复发作的药物超敏反应综合征1例, refAbstract=null), Reference(id=1322930562658337693, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2023, volume=17, issue=6, pageStart=555, pageEnd=561, url=null, language=null, rfNumber=24, rfOrder=23, authorNames=牟雨竹, 陈玲玲, journalName=中华临床免疫和变态反应杂志, refType=null, unstructuredReference=牟雨竹，陈玲玲. IL-5靶向生物制剂在药物超敏反应综合征治疗中的应用［J］. 中华临床免疫和变态反应杂志，2023，17（6）：555-561., articleTitle=IL-5靶向生物制剂在药物超敏反应综合征治疗中的应用, refAbstract=null), Reference(id=1322930562821915550, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2023, volume=27, issue=4, pageStart=388, pageEnd=398, url=null, language=null, rfNumber=25, rfOrder=24, authorNames=Zhu H, Ren V, journalName=J Cutan Med Surg, refType=null, unstructuredReference=Zhu H，Ren V. Immunopathogenic insights on preferential human herpesvirus-6 reactivation in drug rash with eosinophilia and systemic symptoms： a scoping review［J］. J Cutan Med Surg，2023，27（4）：388-398., articleTitle=Immunopathogenic insights on preferential human herpesvirus-6 reactivation in drug rash with eosinophilia and systemic symptoms： a scoping review, refAbstract=null), Reference(id=1322930564482859935, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2023, volume=39, issue=7, pageStart=538, pageEnd=542, url=null, language=null, rfNumber=26, rfOrder=25, authorNames=杨娈, 温禾, 孙青, journalName=中国麻风皮肤病杂志, refType=null, unstructuredReference=杨娈，温禾，孙青. 药物超敏反应综合征的发病机制及治疗进展［J］. 中国麻风皮肤病杂志，2023，39（7）：538-542., articleTitle=药物超敏反应综合征的发病机制及治疗进展, refAbstract=null), Reference(id=1322930564562551712, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, doi=null, pmid=null, pmcid=null, year=2022, volume=14, issue=6, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=27, rfOrder=26, authorNames=Kulkarni MP, Chinta S, Sosa F, journalName=Cureus, refType=null, unstructuredReference=Kulkarni MP，Chinta S，Sosa F，et al. Drug rash with eosinophilia and systemic symptoms （DRESS） syndrome due to vancomycin［J］. Cureus，2022，14（6）：e26219., articleTitle=Drug rash with eosinophilia and systemic symptoms （DRESS） syndrome due to vancomycin, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322930553246319444, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, xref=null, ext=[AuthorCompanyExt(id=1322930553258902357, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, companyId=1322930553246319444, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Dermatology, the First Medical Center of PLA General Hospital, Beijing 100853, China), AuthorCompanyExt(id=1322930553267290966, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, companyId=1322930553246319444, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=解放军总医院第一医学中心皮肤科，北京　100853)])], figs=[ArticleFig(id=1322930557549675386, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=EN, label=Tab. 1, caption=Baseline characteristics of the 34 patients with DIHS, figureFileSmall=null, figureFileBig=null, tableContent=
项目

总例数

(n=34)

男性(n=16)女性(n=18)t/Z值/χ2P值
年龄/(岁，
x¯
±s)		43.6 ± 16.543.4 ± 17.843.8 ± 15.6-0.0700.945

潜伏期/[d，

M(IQR)]

21.0

(11.0 ~ 30.0)

21.0

(13.5 ~ 31.8)

20.5

(7.5 ~ 28.5)

-0.4320.666

既往药物过敏史/

(例，%)

7(20.6)1(6.3)6(33.3)-0.090a
), ArticleFig(id=1322930557620978555, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, label=表1, caption=

34例DIHS患者基本情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目

总例数

(n=34)

男性(n=16)女性(n=18)t/Z值/χ2P值
年龄/(岁，
x¯
±s)		43.6 ± 16.543.4 ± 17.843.8 ± 15.6-0.0700.945

潜伏期/[d，

M(IQR)]

21.0

(11.0 ~ 30.0)

21.0

(13.5 ~ 31.8)

20.5

(7.5 ~ 28.5)

-0.4320.666

既往药物过敏史/

(例，%)

7(20.6)1(6.3)6(33.3)-0.090a
), ArticleFig(id=1322930557683893116, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=EN, label=Tab. 2, caption=Main categories, number of cases, and names of causative drugs in patients with DIHS, figureFileSmall=null, figureFileBig=null, tableContent=
药物种类具体致敏药物例数/%
抗痛风药物别嘌醇5(14.7)
解热镇痛药布洛芬，对乙酰氨基酚2(5.9)
抗菌药头孢类(具体不详，3) ，阿莫西林(2)，莫西沙星(2)，万古霉素，多西环素(2)，阿奇霉素，罗红霉素12(35.3)
抗抑郁药安非他酮(2)2(5.9)
中药抗病毒口服液(2)，复方大青叶合剂，血塞通胶囊(2)，活血化瘀胶囊，通经活血片7(20.6)
抗癫痫药卡马西平(2)，左乙拉西坦(2)4(11.8)
免疫抑制剂沙利度胺/来氟米特1(2.9)
生物制剂阿达木单抗1(2.9)
), ArticleFig(id=1322930557809722237, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, label=表 2, caption=

DIHS患者主要致敏药物种类、例数、名称及潜伏期

, figureFileSmall=null, figureFileBig=null, tableContent=
药物种类具体致敏药物例数/%
抗痛风药物别嘌醇5(14.7)
解热镇痛药布洛芬，对乙酰氨基酚2(5.9)
抗菌药头孢类(具体不详，3) ，阿莫西林(2)，莫西沙星(2)，万古霉素，多西环素(2)，阿奇霉素，罗红霉素12(35.3)
抗抑郁药安非他酮(2)2(5.9)
中药抗病毒口服液(2)，复方大青叶合剂，血塞通胶囊(2)，活血化瘀胶囊，通经活血片7(20.6)
抗癫痫药卡马西平(2)，左乙拉西坦(2)4(11.8)
免疫抑制剂沙利度胺/来氟米特1(2.9)
生物制剂阿达木单抗1(2.9)
), ArticleFig(id=1322930557885219710, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=EN, label=Tab. 3, caption=Major clinical manifestations in the DIHS cases, figureFileSmall=null, figureFileBig=null, tableContent=
受累部位或系统表现例数/%
皮肤发疹样皮疹(11例)，弥漫性红斑(9例)，多形红斑型(5例)，多发性皮损(7例)，脓疱型(2例)34(100)
发热中低热(16例)，高热(≥39.1℃)(10例)26(76.5)
黏膜受累9(26.5)
面部肿胀7(20.6)
淋巴结淋巴结肿大14(41.2)
呼吸系统肺炎，渗出性病变6(17.6)
), ArticleFig(id=1322930557985883007, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, label=表 3, caption=

DIHS患者的主要临床表现

, figureFileSmall=null, figureFileBig=null, tableContent=
受累部位或系统表现例数/%
皮肤发疹样皮疹(11例)，弥漫性红斑(9例)，多形红斑型(5例)，多发性皮损(7例)，脓疱型(2例)34(100)
发热中低热(16例)，高热(≥39.1℃)(10例)26(76.5)
黏膜受累9(26.5)
面部肿胀7(20.6)
淋巴结淋巴结肿大14(41.2)
呼吸系统肺炎，渗出性病变6(17.6)
), ArticleFig(id=1322930558061380480, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=EN, label=Tab. 4, caption=Laboratory findings of patients with DIHS, figureFileSmall=null, figureFileBig=null, tableContent=
检查项目例数/%
血常规
白细胞增多(＞11×109/L)24(70.6)
嗜酸性粒细胞增多(＞1.5×109/L)17(50.0)
异型淋巴细胞增多(＞5%)7(20.6)
肝功能
ALT升高(＞40 U/L)28(82.4)
AST升高(＞40 U/L)23(67.6)
免疫学指标
抗核抗体(ANA)阳性3(8.8)
免疫球蛋白E (IgE)升高4(11.8)
肺炎支原体4(11.8)
病毒感染
EB病毒阳性11(32.4)
单纯疱疹病毒阳性12(35.3)
巨细胞病毒阳性14(41.2)
风疹病毒阳性9(26.5)
柯萨奇病毒阳性1(2.9)
), ArticleFig(id=1322930558216569730, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, label=表 4, caption=

DIHS患者的实验室检查结果

, figureFileSmall=null, figureFileBig=null, tableContent=
检查项目例数/%
血常规
白细胞增多(＞11×109/L)24(70.6)
嗜酸性粒细胞增多(＞1.5×109/L)17(50.0)
异型淋巴细胞增多(＞5%)7(20.6)
肝功能
ALT升高(＞40 U/L)28(82.4)
AST升高(＞40 U/L)23(67.6)
免疫学指标
抗核抗体(ANA)阳性3(8.8)
免疫球蛋白E (IgE)升高4(11.8)
肺炎支原体4(11.8)
病毒感染
EB病毒阳性11(32.4)
单纯疱疹病毒阳性12(35.3)
巨细胞病毒阳性14(41.2)
风疹病毒阳性9(26.5)
柯萨奇病毒阳性1(2.9)
), ArticleFig(id=1322930558308844419, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=EN, label=Tab. 5, caption=Comparison of characteristics between recurrent and non-recurrent patients, figureFileSmall=null, figureFileBig=null, tableContent=
特征

复发患者

(n=7)

非复发

患者(n=27)

t/χ2/

Z值

P值
年龄/(岁，
x¯
±s)		48.0 ± 11.043.4 ± 17.20.6740.410
致敏药物大类/(例，%)
抗菌药4 (57.1)8 (29.6)—0.174a
中药1 (14.3)6 (22.2)—1.000a
其他类药物b2 (28.6)13 (48.1)—0.423a
临床特征
潜伏期/ [d, M(Q1, Q3)]30 (14，35)21 (12, 28)1.6700.095
病情评分/(
x¯
±s)		4.3 ± 1.35.5 ± 1.91.6030.119
实验室检查
肝功能损害/(例，%)5 (71.4)23 (85.2)—0.577a
病毒感染/(例，%)7 (100.0)18 (66.7)—0.084a
治疗情况
激素起始剂量/(mg/d，
x¯
±s)		102.9 ± 62.181.5 ± 46.11.0020.379
激素总用量/(mg/d，
x¯
±s)		1 579.9 ± 683.61 413.2 ± 828.50.5100.620
联用丙种球蛋白/(例，%)3 (42.9)13 (48.1)—1.000a
抗病毒治疗/(例，%)3 (42.9)10(37.0)—1.000a
), ArticleFig(id=1322930560007537540, tenantId=1146029695717560320, journalId=1322258570227581120, articleId=1322930552327766863, language=CN, label=表 5, caption=

复发患者与非复发患者特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征

复发患者

(n=7)

非复发

患者(n=27)

t/χ2/

Z值

P值
年龄/(岁，
x¯
±s)		48.0 ± 11.043.4 ± 17.20.6740.410
致敏药物大类/(例，%)
抗菌药4 (57.1)8 (29.6)—0.174a
中药1 (14.3)6 (22.2)—1.000a
其他类药物b2 (28.6)13 (48.1)—0.423a
临床特征
潜伏期/ [d, M(Q1, Q3)]30 (14，35)21 (12, 28)1.6700.095
病情评分/(
x¯
±s)		4.3 ± 1.35.5 ± 1.91.6030.119
实验室检查
肝功能损害/(例，%)5 (71.4)23 (85.2)—0.577a
病毒感染/(例，%)7 (100.0)18 (66.7)—0.084a
治疗情况
激素起始剂量/(mg/d，
x¯
±s)		102.9 ± 62.181.5 ± 46.11.0020.379
激素总用量/(mg/d，
x¯
±s)		1 579.9 ± 683.61 413.2 ± 828.50.5100.620
联用丙种球蛋白/(例，%)3 (42.9)13 (48.1)—1.000a
抗病毒治疗/(例，%)3 (42.9)10(37.0)—1.000a
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成人药物超敏反应综合征临床特征及预后的单中心分析
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朱文巍 , 宋翠豪 , 申琳 , 汤丽川 , 周勇
解放军医学院学报 | 临床研究论著 2026,47(6): 653-658
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解放军医学院学报 |临床研究论著 2026 , 47 (6) : 653 -658
成人药物超敏反应综合征临床特征及预后的单中心分析
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朱文巍 , 宋翠豪, 申琳, 汤丽川, 周勇
作者信息
  • 解放军总医院第一医学中心皮肤科，北京　100853
通讯作者:
周勇，博士，副主任医师。Email:
作者简介:

朱文巍：论文撰写；宋翠豪：审读和修订；周勇：监督指导；申琳，汤丽川：审读和修订。

朱文巍，硕士，主治医师。Email:

A single-center analysis of clinical characteristics and prognosis of drug-induced hypersensitivity syndrome in adults
Wenwei ZHU , Cuihao SONG, Lin SHEN, Lichuan TANG, Yong ZHOU
Affiliations
  • Department of Dermatology, the First Medical Center of PLA General Hospital, Beijing 100853, China
    • Corresponding Author:
    ZHOU Yong. Email:
出版时间: 2026-06-28 doi: 10.12435/j.issn.2095-5227.25111104
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摘要
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背景

药物超敏反应综合征(drug-induced hypersensitivity syndrome，DIHS)是一种严重且可能致命的药物不良反应，具有潜伏期长、易复发的特点，临床早期识别困难。

目的

分析DIHS患者的临床特征、致敏药物分布、实验室检查异常及预后相关因素，为临床早期识别和治疗提供依据。

方法

收集2015年1月至2025年12月于解放军总医院第一医学中心皮肤科住院治疗的DIHS患者临床资料。根据RegiSCAR评分系统将评分＞5分的患者定义为确诊病例。分析患者的人口学特征、致敏药物、临床表现、实验室检查、治疗及转归。

结果

共纳入34例 DIHS患者，男16例，女18例，平均年龄(43.6±16.5)岁，大部分患者(76.5%)集中在(30 ~ 55)岁。患病潜伏期(2 ~ 60) d，中位数为21(IQR：11 ~ 30) d。临床表现上除皮疹外，肝功能损害发生率极高(28例，82.4%)。主要致敏药物包括抗菌药12例(35.3%)、中药7例(20.6%)、抗痛风药5例(14.7%)、抗癫痫药4例(11.8%)，解热镇痛药2例(5.9%)、抗抑郁药2例(5.9%)，但也有免疫抑制剂1例和生物制剂1例。实验室检查显示白细胞升高24例(70.6%)，嗜酸性粒细胞增多17例(50.0%)；伴巨细胞病毒感染14例(41.2%)，单纯疱疹病毒感染12例(35.3%)、EB病毒阳性感染11例(32.4%)、风疹病毒阳性9例(26.5%)、柯萨奇病毒阳性1例(2.9%)、肺炎支原体阳性4例(11.8%)。所有患者均接受糖皮质激素治疗，近半数(16例，47.1%)联合静脉用丙种球蛋白。34例患者治疗后近期均达临床缓解，总有效率100%；远期随访中27例治愈(79.4%)，7例复发(20.6%)。复发组潜伏期显著长于非复发组[(34.9±19.0) d vs (20.2±11.4) d，P=0.015]。

结论

本研究DIHS病例呈现出潜伏期较长的特点，抗菌药和中药是主要致敏药物，肝功能损害常见。早期识别、及时停用致敏药物并给予糖皮质激素治疗疗效确切。病毒感染可能与复发相关，但抗病毒治疗价值尚需验证。

药物超敏反应综合征  /  药物反应伴嗜酸性粒细胞增多和系统症状  /  临床特征  /  致敏药物  /  预后
Background

Drug-induced hypersensitivity syndrome (DIHS) is a severe, potentially life-threatening adverse drug reaction marked by a prolonged latency period and frequent relapses, posing significant challenges for early clinical recognition.

Objective

To analyze the clinical characteristics, distribution of culprit drugs, laboratory abnormalities, and prognostic factors in patients with drug-induced hypersensitivity syndrome (DIHS), so as to provide evidence for early clinical identification and treatment.

Methods

Clinical data were collected from patients with DIHS who were hospitalized in the Department of Dermatology, the First Medical Center of PLA General Hospital from January 2015 to December 2025. Patients with a RegiSCAR score ＞5 were defined as confirmed cases. The demographic characteristics, culprit drugs, clinical manifestations, laboratory findings, treatment, and outcomes of the patients were analyzed.

Results

A total of 34 patients diagnosed with DIHS were enrolled in this study, including 16 males and 18 females, with a mean age of (43.6±16.5) years. Most patients (76.5%) were aged between 30 and 55 years. The incubation period of the disease ranged from 2 to 60 days, with a median of 21 (IQR: 11 - 30) d. In terms of clinical manifestations, aside from skin rash, liver function impairment had an extremely high incidence (28 cases, 82.4%). The main causative sensitizing drugs included antibacterial agents (12 cases, 35.3%), traditional Chinese medicine (7 cases, 20.6%), anti-gout drugs (5 cases, 14.7%), and anti-epileptic drugs (4 cases, 11.8%), antipyretic and analgesic agents in 2 cases (5.9%),antidepressant medications in 2 cases (5.9%),additionally, 1 case was induced by an immunosuppressant and 1 case by a biological agent. Laboratory examinations revealed leukocytosis in 24 cases (70.6%) and eosinophilia in 17 cases (50.0%). Concomitant viral or pathogen infections were detected as follows: cytomegalovirus infection in 14 cases (41.2%), herpes simplex virus infection in 12 cases (35.3%), Epstein-Barr virus positive infection in 11 cases (32.4%), rubella virus positive infection in 9 cases (26.5%), Coxsackievirus positive in 1 case (2.9%), and mycoplasma pneumoniae positive in 4 cases (11.8%). All patients received glucocorticoid therapy, and nearly half (16 cases, 47.1%) received combined treatment with intravenous immunoglobulin. All 34 patients achieved short-term clinical remission after treatment, with an overall response rate of 100%; during long-term follow-up, 27 cases (79.4%) were cured and 7 cases (20.6%) experienced recurrence. The incubation period of the recurrence group was significantly longer than that of the non-recurrence group ([34.9±19.0] d vs [20.2±11.4] d, P=0.015).

Conclusion

DIHS cases in our center are characterized by a relatively long latency period. Antibacterials and traditional Chinese herbal medicines are the predominant culprit drugs, and liver function impairment is common. Early recognition, prompt withdrawal of the offending drug, and administration of systemic corticosteroids yield definite therapeutic efficacy. Viral infections may be associated with disease relapse, although the value of antiviral therapy remains to be validated.

drug-induced hypersensitivity syndrome  /  drug reaction with eosinophilia and systemic symptoms  /  clinical characteristics  /  causative drugs  /  prognosis
朱文巍, 宋翠豪, 申琳, 汤丽川, 周勇. 成人药物超敏反应综合征临床特征及预后的单中心分析. 解放军医学院学报, 2026 , 47 (6) : 653 -658 . DOI: 10.12435/j.issn.2095-5227.25111104
Wenwei ZHU, Cuihao SONG, Lin SHEN, Lichuan TANG, Yong ZHOU. A single-center analysis of clinical characteristics and prognosis of drug-induced hypersensitivity syndrome in adults[J]. Academic Journal of Chinese PLA Medical School, 2026 , 47 (6) : 653 -658 . DOI: 10.12435/j.issn.2095-5227.25111104
正文
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药物超敏反应综合征(drug-induced hypersensitivity syndrome，DIHS)是药物超敏反应中的一种特殊类型，特征包括发热、皮疹和多器官受累，伴或不伴嗜酸性粒细胞增多和异型淋巴细胞出现，可能累及肝脏(肝炎)和心脏(超敏反应性心肌炎)。该反应又称为伴嗜酸性粒细胞增多和系统症状的药物反应(drug reaction with eosinophilia and systemic symptoms，DRESS)[1]，尽管命名体系不同，但属于同一疾病谱[2]。DIHS通常在开始用药后2周至2个月出现特征性表现，具有潜伏期长和潜在致死性的特点[2]。尽管国内外对DIHS已有一定研究，但欧美报道致敏药物以抗癫痫药和别嘌醇为主[3]，而我国致敏谱存在差异且相关大规模研究不足；病毒再激活与疾病复发的关系及抗病毒治疗的价值仍存争议。本研究回顾性分析了解放军总医院第一医学中心皮肤科近11年收治的DIHS患者病历资料，总结本中心该病的临床特征并分析预后因素，旨在为DIHS的早期识别与治疗提供依据。
1 对象与方法
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1.1 研究对象
通过医院住院管理系统检索病案，选取2015年1月至2025年12月在解放军总医院第一医学中心皮肤科住院且诊断为“药物超敏反应综合征伴嗜酸性粒细胞增多和系统症状的药物反应”的患者。纳入标准：(1)符合欧洲严重皮肤不良反应登记处(RegiSCAR)提出的DIHS/DRESS诊断评分系统[4]，评分＞5分(确诊病例)；(2)临床资料完整。排除标准：(1)其他发热伴皮疹疾病，如传染性单核细胞增多症、麻疹、成人斯蒂尔病、血液系统疾病、自身免疫性疾病等；(2)失访或随访时间不足3个月。诊断标准：采用RegiSCAR评分系统[4]：(1)需要住院治疗；(2)药物相关反应；(3)急性发疹；(4)体温＞38℃；(5)两处以上淋巴结肿大；(6)脏器受累；(7)血液学异常(嗜酸性粒细胞升高、血小板降低或出现异型淋巴细胞)。RegiSCAR评分系统评分＞5分为确诊病例。
病情严重程度分型标准[5]：参照《药物超敏反应综合征诊治专家共识(2018版)》及国内外通用标准，将满足以下条件之一者定义为重症DIHS：(1)剥脱性皮炎/红皮病面积≥90%；(2)伴发严重内脏损害(如ALT/AST＞5倍正常上限、间质性肺炎伴呼吸衰竭等)；(3)出现严重血液系统受累(如白细胞＞20×109/L或嗜酸性粒细胞＞2.5×109/L)。其余患者归为轻症DIHS。
本研究经解放军总医院第一医学中心医学伦理委员会批准(批号：S2025-779-01)，回顾性研究豁免知情同意，所有患者信息均匿名化处理。
1.2 主要分析指标
(1)一般资料：性别、年龄、既往史、用药史、药物过敏史；(2)临床特征：潜伏期(从开始用药至首发症状出现的时间)、皮疹类型、发热特点、黏膜损害、淋巴结肿大、内脏受累情况；(3)实验室检查：血常规、肝功能、病毒学检测(EB病毒、巨细胞病毒、单纯疱疹病毒、风疹病毒等)、肺炎支原体、自身抗体；(4)治疗及转归：治疗方案(糖皮质激素起始剂量、总用量，是否联合丙种球蛋白或抗病毒治疗)，住院时间，疗效，复发情况，结局(死亡)。
1.3 相关定义
1.3.1 肝功能损害
丙氨酸氨基转移酶(alanine aminotransferase，ALT)＞40 U/L和(或)天冬氨酸氨基转移酶(aspartate aminotransferase，AST)＞40 U/L。根据ALT水平分为轻度(＜80 U/L)和中重度(≥80 U/L)。
1.3.2 近期疗效判定[6](指出院时状态)
(1)治愈：皮疹完全消退，可遗留色素沉着，临床症状消失；(2)有效：皮疹明显减轻，病情无进展，自觉症状好转；(3)无效：与治疗前相比无明显好转或加重。总有效率=(治愈+有效)/总例数×100%。
1.3.3 临床缓解
达到治愈或有效标准，病情稳定允许出院或转为门诊随访减量
1.3.4 复发(指远期预后)
达到临床缓解出院后，皮疹再次出现或原有皮疹加重，伴或不伴发热，需再次入院治疗或增加糖皮质激素剂量。
1.4 统计学分析
采用SPSS 22.0软件进行统计分析。正态分布的计量资料采用shapiro-wilk检验，以均数±标准差(
x¯
 ± s)表示，组间比较采用独立样本t检验；非正态分布资料以中位数(四分位数间距或范围)表示，组间比较采用Mann-Whitney U检验。计数资料以频数(百分比)表示，组间比较采用χ2检验或Fisher精确检验。以双侧P＜0.05为差异有统计学意义。
2 结果
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2.1 患者纳入流程及临床资料
选取2015年1月至2025年12月皮肤科住院患者，初步诊断DIHS/DRESS 44例，经筛查8例因病毒感染、药物史、嗜酸性粒细胞水平、病毒再激活等DIHS的诊断要素不完备，排除DIHS。1例误诊患者入院时表现为全身淋巴结肿大伴剥脱性皮炎，后经淋巴结活检及外周血流式细胞学检查明确诊断为外周T细胞淋巴瘤。1例疑似病例因临床资料不完整且患者死亡失访，予以排除。
最终纳入分析34例确诊病例。男16例，女18例，年龄18 ~ 71岁，平均年龄(43.6 ± 16.5)岁。其中2例既往青霉素及头孢过敏史，1例多西环素致敏住院病史，1例磺胺类药物过敏史，1例可疑布洛芬、左氧氟沙星过敏，1例既往有药物过敏史但具体药物不明，1例头孢呋辛钠过敏史。患病潜伏期(2 ~ 60) d，中位数为21.0(IQR：11.0 ~ 30.0) d。见表1。
2.2 可疑致敏药物
最常见的3种药物分别为抗菌药(12例)、中药(7例)和抗痛风药(5例)，免疫抑制剂和生物制剂各1例，见表2。
2.3 症状与体征
34例患者均出现皮疹，其中发疹样皮疹11例(32.4%)，弥漫性红斑9例(26.5%)，多形红斑型5例(14.7%)，多发性皮损7例(20.6%)，脓疱型2例(5.9%)。26例(76.5%)伴发热，其中16例为中低型，10例高型，先发热后发疹12例(46.2%)、先发疹后发热5例(19.2%)、同时出现9例(34.6%)。14例(41.2%)伴淋巴结肿大，常见于颈部、腋窝及腹股沟等处。9例(26.5%)伴黏膜损害。6例(17.6%)合并肺部损害。见表3。
2.4 实验室及辅助检查结果
28例(82.4%)患者出现肝功能异常，其中ALT升高28例、AST升高23例。24例(70.6%)白细胞总数升高(＞11×109/L)，17例(50.0%)嗜酸性粒细胞明显升高(＞1.5×109/L)，7例(20.6%)异型淋巴细胞增多(＞5%)。抗核抗体(antinuclear antibody，ANA)阳性3例(8.8%)，IgE升高4例(11.8%)。见表4。
病毒感染检测：25例(73.5%)患者伴病毒感染，其中EB病毒阳性11例(32.4%)，单纯疱疹病毒阳性12例(35.3%)，巨细胞病毒阳性14例(41.2%)，风疹病毒阳性9例(26.5%)，柯萨奇病毒阳性1例(2.9%)。13例(38.2%)患者存在单一病原体感染，余12例(35.3%)患者存在两种或两种以上病原体混合感染。病毒感染患者病情评分与未感染者差异无统计学意义(5.2±1.6 vs 5.0±1.6，P=0.750)。
2.5 治疗
所有患者均立即停用可疑致敏药物，接受糖皮质激素治疗(甲泼尼龙静脉给药)，起始剂量为40 ~ 240 mg/d。16例(47.1%)重症患者联合静脉注射用丙种球蛋白0.4 g/(kg·d)，连用3 ~ 5 d。3例患者在糖皮质激素冲击治疗基础上加用阿达木单抗。
12例(35.3%)患者给予静脉更昔洛韦抗病毒治疗，主要针对巨细胞病毒和单纯疱疹病毒感染并病情症状严重者。1例未检出病毒患者接受更昔洛韦抗病毒治疗，系因病情较重，临床医师给予经验性抗病毒治疗，旨在覆盖潜在的疱疹病毒再激活，避免加重病情。
2.6 转归
34例患者中位住院时间为15.0(IQR：7.0 ~ 76.0) d，经治疗均达到临床缓解并出院，近期疗效总有效率为100%。随访期间27例(79.4%)停药后未复发，达到治愈；余7例(20.6%)在临床缓解后出院，随访减量期间或停药后复发。全组无无效或死亡病例。
2.7 复发患者特征分析
本研究中，复发组与非复发组在年龄、病情评分、潜伏期、肝功能损害发生率、激素使用剂量及治疗方案等方面比较，差异均无统计学意义(P＞0.05)，但受样本量限制，均衡性结论要谨慎。无病毒感染的患者复发率为0；复发患者病毒感染率(100%)高于非复发患者66.7%(18/27)，差异无统计学意义(P=0.084)，可能与样本量较小有关。见表5。
3 讨论
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药物超敏反应综合征是一种潜伏期长、病死率高且易复发的严重药物不良反应[2]，始终是皮肤科及变态反应领域的诊治难点。尽管国际上对该病的免疫机制已有深入认识[5]，但针对我国成人住院人群的致敏谱特征及病毒再激活与复发的关系仍需进一步研究。本研究通过对本中心近11年34例成人DIHS患者的回顾性分析，总结了该病的临床特征与预后规律，为该病的临床早期识别与精准干预提供了临床参考。
本研究显示，抗菌药(35.3%)和中药(20.6%)是本队列中最主要的致敏药物，其次为抗痛风药(别嘌醇，14.7%)和抗癫痫药(11.8%)。这一分布与欧美研究中抗癫痫药和别嘌醇占主导的模式存在差异，但与国内近年多个研究结果相符[7]。这种差异可能反映了我国医疗中抗菌药及中药制剂广泛使用的现状[8]。值得注意的是，本队列中发现了1例阿达木单抗及1例沙利度胺/来氟米特相关的DIHS。虽然生物制剂及免疫抑制剂致DIHS极为罕见，且多为个案报道[9]，但其临床表现往往不典型，易被误诊为原发病进展或输液反应[10]。这提示在临床实践中，对于接受免疫调节治疗的患者出现迟发性皮疹和全身症状时，需拓宽诊断思路，亦应将DIHS纳入鉴别诊断范围。
本研究潜伏期(中位数21 d)与文献报道的2周 ~ 2个月相符[11-12]。别嘌醇潜伏期(平均35 d)最长与文献报道抗癫痫药潜伏期最长不完全一致[13-14]，这种差异可能与样本量不足有关。本研究提示使用别嘌醇后需长期监测。肝功能损害是DIHS最常见的内脏受累表现[15-16]，本研究发生率为82.4%，与文献报道的75% ~ 94%基本一致[17-18]。本研究复发率为20.6%，与文献报道的20% ~ 30%基本一致[5,9]。有研究建立了DIHS预后预测评分系统，可帮助识别复发高风险患者,也有其他研究总结复发可能与激素减量过快、自行停药或者病毒再激活相关[19]。本研究中患者病毒标志物总阳性率高达73.5%，以巨细胞病毒(41.2%)、单纯疱疹病毒(35.3%)和EB病毒(32.4%)最为常见，所有复发患者(7/7)均伴有至少一种病毒感染，未复发患者中病毒感染比例为66.7%(18/27)，虽然差异未达到统计学显著性(P=0.084)，但这一趋势有重要临床警示意义。结合复发组潜伏期显著长于非复发组[(34.9±19.0) d vs (20.2±11.4) d，P=0.015]的结果，本研究推测较长的潜伏期为病毒复制和免疫紊乱的持续提供了时间窗，从而增加了复发风险。这表明，病毒再激活虽不一定是疾病发生的始动因素，但可能是维持炎症循环、导致复发的关键环节[20-22]。
糖皮质激素仍是DIHS的一线治疗药物[11,19]，减量过快或自行停药可能导致病情反复[23] 。本研究所有病例采用中等至大剂量激素(40 ~ 240 mg/d甲泼尼龙等效剂量)，治疗后临床缓解，与既往报道一致。对于重症患者，常联合治疗。本研究中有3例重症患者，按临床决策尽早干预原则，入院治疗初期启动激素冲击联合阿达木单抗治疗，疗效良好，3例均治愈且无复发。目前生物制剂的联合使用，需基于充分的获益-风险评估后再决策实施[24]。抗病毒治疗的应用存在争议，本研究未发现抗病毒治疗改善预后的证据，但受指征偏倚限制，不能据此评价疗效[25-26]。
本研究存在一定的局限性。首先，作为单中心回顾性研究，以重症患者为主，样本量较小(n=34)，可能导致统计效能不足，特别是在复发因素分析中。其次，病毒检测多为单次血清学检测，难以区分病毒再激活与原发感染，亦无法动态监测病毒载量变化。第三，治疗方案的选择可能存在治疗指征偏倚，无法确立因果关系。
综上所述，DIHS在本中心皮肤科住院患者中呈现出以抗菌药和中药为主的致敏谱，生物制剂及免疫抑制剂致敏虽罕见但需警惕。临床医师应高度重视病毒再激活与疾病复发之间的潜在联系；对于潜伏期长、伴有病毒感染的重症患者，建议采取个体化、缓慢的糖皮质激素减量策略，并关注联合治疗在重症管理中的价值[27]。后续研究应推进多中心联合研究或DIHS病例登记系统建设，开展大样本队列研究分析以验证病毒再激活在复发中的确切作用，并探索更为优化的治疗路径。

文献
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doi: 10.12435/j.issn.2095-5227.25111104
  • 接收时间：2025-11-11
  • 首发时间：2026-10-30
  • 出版时间：2026-06-28
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  • 收稿日期：2025-11-11
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    解放军总医院第一医学中心皮肤科，北京　100853

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周勇，博士，副主任医师。Email:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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