中国新药杂志

241例抗菌药物致重型药疹的回顾性分析

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曹明雪 ¹ , 黄雅群 ¹^,² , 张姣 ¹^,² , 于芝颖 ¹ , 文睿婷 ¹ , 封宇飞 ¹

中国新药杂志 | 药物安全与合理用药 2021,30(24): 2322-2327

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中国新药杂志 |药物安全与合理用药 2021 , 30 (24) : 2322 -2327

241例抗菌药物致重型药疹的回顾性分析

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曹明雪¹, 黄雅群¹^,², 张姣¹^,², 于芝颖¹, 文睿婷¹, 封宇飞¹

作者信息

¹北京大学人民医院药剂科，北京　100044

²北京大学医学部药学院药事管理与临床药学系，北京　100191

通讯作者:

文睿婷，女，博士，副主任药师，主要从事临床药学及药理学研究。联系电话：（010）88325749，E-mail：tzwxm@bjmu.edu.cn。

作者简介:

曹明雪，女，硕士研究生，主要从事临床药学及药事管理研究。联系电话：（010）88325749，E-mail：xiaoming68250@163.com。

Retrospective analysis of 241 cases of severe cutaneous adverse reactions caused by antibiotics

Ming-xue CAO¹, Ya-qun HUANG¹^,², Jiao ZHANG¹^,², Zhi-ying YU¹, Rui-ting WEN¹, Yu-fei FENG¹

Affiliations

¹Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China

²Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China

出版时间: 2021-12-30

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摘要

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目的：

探讨抗菌药物致重型药疹的临床特点，为临床安全、合理使用抗菌药物提供参考。

方法：

在Medline、中国知网、万方数据库中，检索建库至2020年12月31日关于抗菌药物致重型药疹的个案报道，进行汇总分析。并用二元Logistic回归进行危险因素分析。

结果：

共收集病例241例，其中男性131例（54.4%）、女性110例（45.6%），可发生于任何年龄段，不良反应发生中位时间为2 d，持续中位时间为15 d；致敏药物主要为青霉素类55例（21.7%）、氟喹诺酮类46例（18.2%）、头孢菌素类39例（15.4%）、糖肽类25例（9.9%）等；中毒性表皮坏死松解症患者较重型多型红斑患者[相对危险度（odd ratio，OR）=0.263，P=0.006]和剥脱性皮炎患者（OR=0.52，P=0.016）死亡风险更高（P<0.05）；相较于对症支持治疗给予糖皮质激素（OR=0.117，P=0.027）或免疫球蛋白治疗（OR=0.042，P=0.001）患者死亡风险降低，糖皮质激素联合免疫球蛋白治疗较对症支持治疗未见统计学差异（OR=0.899，P=0.950）。

结论：

抗菌药物致重型药疹死亡风险高，临床需加强监测，早期识别诊治，选择结构不同的抗菌药物进行替代治疗，避免重型药疹复发。

关键词

抗菌药物 / 重型药疹 / 不良反应 / 文献分析

Abstract

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Objective:

To investigate the clinical characteristics of severe drug eruption induced by antibacterial drugs and provide aid for their safe use in clinical practice.

Methods:

Case reports of severe cutaneous adverse reactions induced by antibacterial drugs were retrieved from Medline, CNKI and Wanfang databases from inception to December 31, 2020. The clinical features of these ADRs were summarized and analyzed. The risk factors were analyzed by binary Logic regression.

Results:

A total of 241 cases were collected, including 131 males (54.4%) and 110 females (45.6%). Severe cutaneous adverse reactions (SCARs) occurred in all age groups. The median onset time of antibacterial drugs-induced SCARs was 2 d and the median duration was 15 d. The main allergenic drugs were penicillin (55/21.7%), fluoroquinolones (46/18.2%), cephalosporins (39/15.4%), and glycopeptides (25/9.9%). Patients with toxic epidermal necrolysis (TEN) had a higher risk of death than Steven Johnson syndrome (SJS) [odd ratio (OR)=0.263, P=0.006] and exfoliative dermatitis (ED) (OR=0.52, P=0.016) (P<0.05); patients treated with glucocorticoid (OR=0.117, P=0.027) or immunoglobulin (OR=0.042, P=0.001) had a lower risk of death than treated with symptomatic supportive care. There was no statistical difference between glucocorticoid combined with immunoglobulin therapy and symptomatic supportive therapy (OR=0.899, P=0.950).

Conclusion:

The mortality of severe drug eruption caused by antimicrobial drugs is high, so it is necessary to strengthen the monitoring of early signs in clinical practice, and immediately stop using suspicious drugs, and choose alternative antimicrobial drugs with different structures to avoid the recurrence of severe cutaneous adverse reactions.

Key words

antibacterial drugs / severe drug eruption / adverse reactions / literature analysis

引用本文

曹明雪, 黄雅群, 张姣, 于芝颖, 文睿婷, 封宇飞. 241例抗菌药物致重型药疹的回顾性分析. 中国新药杂志, 2021 , 30 (24) : 2322 -2327 .

Ming-xue CAO, Ya-qun HUANG, Jiao ZHANG, Zhi-ying YU, Rui-ting WEN, Yu-fei FENG. Retrospective analysis of 241 cases of severe cutaneous adverse reactions caused by antibiotics[J]. Chinese Journal of New Drugs, 2021 , 30 (24) : 2322 -2327 .

基金

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国家自然科学基金资助项目(81503050)
中国药理学会药物研发与合理应用专项资助项目(20170711)

参考文献

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文献

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参考文献引证文献

排序方式：

[1]

DUONG TA, VALEYRIE-ALLANORE L, WOLKENSTEIN P, et al. Severe cutaneous adverse reactions to drugs[J]. Lancet, 2017, 390(10106): 1996-2011.

[2]

PATEL TK, BARVALIYA MJ, SHARMA D, et al. A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population[J]. Indian J Dermatol Venereol Leprol, 2013, 79(3): 389-398.

[3]

国家药品不良反应监测年度报告(2019年)[J]. 中国药物评价, 2019, 36(6): 476-480.

[4]

LIN YF, YANG CH, SINDY H, et al. Severe cutaneous adverse reactions related to systemic antibiotics[J]. Clin Infect Dis, 2014, 58(10): 1377-1385.

[5]

中华医学会. 临床技术操作规范. 皮肤病与性病分册[M]. 北京: 人民军医出版社, 2006.

[6]

《中国国家处方集》编委会. 中国国家处方集(化学药品与生物制品卷)[M]. 北京: 人民军医出版社, 2010.

[7]

NORI S, NEBESIO C, BRASHEAR R, et al. Moxifloxacin-associated drug hypersensitivity syndrome with toxic epidermal necrolysis and fulminant hepatic failure[J]. Arch Dermatol, 2004, 140(12): 1537-1538.

[8]

GOMES ESR, MARQUES ML, REGATEIRO FS. Epidemiology and risk factors for severe delayed drug hypersensitivity reactions[J]. Curr Pharm Des, 2019, 25(36): 3799-3812.

[9]

曹媛, 邓蓉蓉, 夏延哲. 36例重型药疹分析[J]. 中国药事, 2016, 30(5): 522-526.

[10]

高红. 重型药疹27例临床分析[J]. 中国处方药, 2015, 13(2): 32-33.

[11]

朱桂芝, 魏述强, 王淑琳, 等. 重型药疹34例临床分析[J]. 中国临床研究, 2012, 25(7): 663-664.

[12]

GAMBOA PM. The epidemiology of drug allergy-related consultations in Spanish Allergology services: Alergológica-2005[J]. J Investig Allergol Clin Immunol, 2009, 19(Suppl 2): S45-S50.

[13]

HALEVY S, GROSSMAN N. Multiple drug allergy in patients with cutaneous adverse drug reactions diagnosed by in vitro drug-induced interferon-gamma release[J]. Isr Med Assoc J, 2008, 10(12): 865-868.

[14]

PICHLER WJ. Pharmacological interaction of drugs with antigen-specific immune receptors: the p-i concept[J]. Curr Opin Allergy Clin Immunol, 2002, 2(4): 301-305.

[15]

骆肖群, 熊浩, 杨凡萍, 等. 重症药疹免疫学发病机制[M]. 2019首届全国湿疹皮炎皮肤过敏学术会议论文汇编. 2019: 27.

[16]

PICHLER WJ, ADAM J, WATKINS S, et al. Drug hypersensitivity: how drugs stimulate T cells via pharmacological interaction with immune receptors[J]. Int Arch Allergy Immunol, 2015, 168(1): 13-24.

[17]

SCHNECK J, FAGOT JP, SEKULA P, et al. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study on patients included in the prospective EuroSCAR Study[J]. J Am Acad Dermatol, 2008, 58(1): 33-40.

[18]

BROWN KM, SILVER GM, HALERZ M, et al. Toxic epidermal necrolysis: does immunoglobulin make a difference?[J]. J Burn Care Rehabil, 2004, 25(1): 81-88.

[19]

FAYE O, ROUJEAU JC. Treatment of epidermal necrolysis with high-dose intravenous immunoglobulins (IV Ig): clinical experience to date[J]. Drugs, 2005, 65(15): 2085-2090.

[20]

STELLA M, CLEMENTE A, BOLLERO D, et al. Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS): Experience with high-dose intravenous immunoglobulins and topical conservative approach: a retrospective analysis[J]. Burns, 2007, 33(4): 452-459.

[21]

STELLA M, CASSANO P, BOLLERO D, et al. Toxic epidermal necrolysis treated with intravenous high-dose immunoglobulins: our experience[J]. Dermatology, 2001, 203(1): 45-49.

[22]

KIM KJ, LEE DP, SUH HS, et al. Toxic epidermal necrolysis: analysis of clinical course and SCORTEN-based comparison of mortality rate and treatment modalities in Korean patients[J]. Acta Derm Venereol, 2005, 85(6): 497-502.

[23]

CHEN J, WANG B, ZENG Y, et al. High-dose intravenous immunoglobulins in the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis in Chinese patients: a retrospective study of 82 cases[J]. Eur J Dermatol, 2010, 20(6): 743-747.

[24]

CAMPIONE E, MARULLI GC, CARROZZO AM, et al. High-dose intravenous immunoglobulin for severe drug reactions: efficacy in toxic epidermal necrolysis[J]. Acta Derm Venereol, 2003, 83(6): 430-432.

[25]

RIRIE MR, BLAYLOCK RC, MORRIS SE, et al. Intravenous immune globulin therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis complicated by hemolysis leading to pigment nephropathy and hemodialysis[J]. J Am Acad Dermatol, 2013, 69(2): 221-225.

[26]

MAURI-HELLWEG D, ZANNI M, FREI E, et al. Cross-reactivity of T cell lines and clones to beta-lactam antibiotics[J]. J Immunol, 1996, 157(3): 1071-1079.

[27]

SEKULA P, DUNANT A, MOCKENHAUPT M, et al. Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. J Invest Dermatol, 2013, 133(5): 1197-1204.

[28]

THONG BY. Update on the management of antibiotic allergy[J]. Allergy Asthma Immunol Res, 2010, 2(2): 77-86.

2021年第30卷第24期

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首发时间：2026-10-28
出版时间：2021-12-30

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录用日期：2021-11-08

基金

国家自然科学基金资助项目(81503050)

中国药理学会药物研发与合理应用专项资助项目(20170711)

作者信息

¹北京大学人民医院药剂科，北京　100044

²北京大学医学部药学院药事管理与临床药学系，北京　100191

通讯作者:

文睿婷，女，博士，副主任药师，主要从事临床药学及药理学研究。联系电话：（010）88325749，E-mail：tzwxm@bjmu.edu.cn。

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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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