福建地区107例重症药疹临床分析

发布时间：2018-08-12 11:24

【摘要】：目的:通过分析107例重症药疹患者临床资料,探讨福建地区重症药疹的流行及临床特点。方法:本次病例来源为2010-2012年期间福建医科大学附属第一医院、泉州市第一医院、厦门市第一医院收治的符合重症药疹诊断的107例住院患者,所有研究对象均符合诊断标准、纳入标准。对重症药疹分型、致敏药物、性别、年龄、潜伏期进行描述,并运用非参数检验的方法对不同致敏药物所致SCDR患者性别和年龄,不同类型SCDR患者的相关实验室检查结果进行独立样本检验,同时运用双变量方法分析相关实验室检查结果与控制激素剂量的相关性,最后运用多分类等级logistic方法分析多因素与预后的关系。结果:2010年-2012年期间福建地区三所医院住院重症药疹男性患者人数略多于女性患者,其男女比例为1.18:1,且三年来发病人数逐年增长,其中以SJS患者最为多见。福建地区导致重症药疹的致敏药物以抗生素类药物最为常见,其他依次为抗癫痫及精神类药物、别嘌呤醇、中药及成药类、解热镇痛药。而在不同致敏药物所致的重症药疹中其性别分布无显著差异(P0.05),而别嘌呤醇所致重症药疹患者的平均年龄较其他患者大,具有统计学差异(P0.05)。在三型重症药疹中以DIHS的潜伏期最长。在重症药疹患者中以AST升高最为常见。在三种类型药疹中ALT、E、WBC在DIHS中异常较其他类型药疹更为明显,其差异具有统计学意义(P0.05),而NE%升高在TEN较其他两种类型重症药疹差异更为明显(P0.05)。而对于不同药物所致的重症药疹,BUN、肌酐在别嘌呤醇中的升高较其他药物所致重症药疹更为明显(P0.05)。而发热、NE%、AST、ALT、粘膜受累情况与控制激素剂量均成正比(R值0),且具有明显统计学意义(P0.05)。而性别、年龄、肌酐、尿素氮与控制激素剂量之间相关性没有统计学意义(P0.05)。对于预后来说,年龄、BUN均与其有关,年龄越大、BUN水平越高,预后越差。结论:1.福建地区重症药疹的发病呈上升趋势,其主要致敏药物为抗生素类、抗癫痫及精神类、别嘌呤醇。2.别嘌呤醇所致的重症药疹其患病年龄较其他药物所致重症药疹更大。3.在重症药疹中AST升高最为常见,在DIHS患者中ALT、E、WBC异常较其他类型药疹更为明显,而NE%升高在TEN较其他两种类型重症药疹更为明显。4别嘌呤醇所致重症药疹患者其肾功能异常较其他药物所致的重症药疹更为常见。5.年龄越大,BUN值越高,预后越差。
[Abstract]:Objective: to investigate the prevalence and clinical characteristics of severe drug eruption in Fujian province by analyzing the clinical data of 107 patients with severe drug eruption. Methods: from 2010 to 2012, 107 patients with severe drug rash were admitted from the first affiliated Hospital of Fujian Medical University, the first Hospital of Quanzhou City and the first Hospital of Xiamen City. All the subjects met the diagnostic criteria. Inclusion criteria The classification of severe drug eruption, sensitizer, sex, age, incubation period were described. The sex and age of SCDR patients caused by different sensitizers were analyzed by nonparametric test. The results of related laboratory tests of different types of SCDR patients were tested by independent samples, and the correlation between the results of related laboratory tests and the dose of control hormone was analyzed by using the bivariate method. Finally, the relationship between multiple factors and prognosis was analyzed by multi-classification logistic method. Results: from 2010 to 2012, the number of male patients with severe drug rash was slightly higher than that of female patients in three hospitals of Fujian province, the ratio of male to female was 1.18: 1, and the number of patients with severe drug rash increased year by year in the past three years, among which SJS patients were the most common. Antibiotics are the most common drugs causing severe drug rash in Fujian area. The others are antiepileptic and psychoactive drugs allopurinol Chinese medicine and patent medicine antipyretic analgesics. However, there was no significant difference in the sex distribution of severe drug rash caused by different sensitizers (P0.05), while the average age of patients with severe drug eruption induced by allopurinol was longer than that of other patients (P0.05). The latency of DIHS was the longest in type 3 severe drug rash. AST elevation is most common in patients with severe drug rash. In the three types of drug rash, the abnormality of ALT EW BC in DIHS was more obvious than that in other types of drug rash, and the difference was statistically significant (P0.05), while the increase of NE% in TEN was more significant than that in other two types of severe drug rash (P0.05). However, the elevation of creatinine in allopurinol was more obvious than that in other drugs (P0.05). However, the incidence of mucosal involvement was directly proportional to the dose of control hormone (R value 0), and had significant statistical significance (P0.05). Sex, age, creatinine, urea nitrogen and control hormone dose were not significantly correlated (P0.05). Age bun was associated with the prognosis. The older the age, the higher the bun level, the worse the prognosis. Conclusion 1. The incidence of severe drug rash in Fujian Province is on the rise, and the main sensitizing drugs are antibiotics, antiepileptic and psychotic, allopurinol. 2. Severe drug rash caused by allopurinol is more. 3. 3 years old than that caused by other drugs. In severe drug rash, the increase of AST was most common, and the abnormality of AST in DIHS patients was more obvious than that in other types of drug rash. In TEN patients with severe drug rash induced by allopurinol, renal dysfunction was more common than that caused by other drugs. The older the age, the higher the bun value, the worse the prognosis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R758.25

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