147例药物性皮炎的临床资料分析及相关病毒的检测

发布时间：2019-05-31 20:12

【摘要】：目的：收集并分析147例住院的药物性皮炎患者临床资料,观察药物性皮炎患者人疱疹病毒(HHV-6、HHV-7、EBV、CMV)及细小病毒(PVB19)的感染状况。方法：1.收集2010年9月到2013年3月入住我院的药物性皮炎患者及正常对照者的血清；2.采用酶联免疫吸附法检测血清中HHV-6、 HHV-7、EBV、CMV及PVB19抗体；3分析药物超敏反应综合征(DIHS)患者、重症药疹患者、非重症药疹患者及正常人病毒感染的差异；4.对药物性皮炎患者的年龄、性别、药疹类型、致敏药物、临床特点等与病毒感染进行相关分析,并将病毒感染与部分临床资料进行综合分析。结果：1、DIHS组、重症药疹组、非重症药疹组患者性别无显著差异；重症药疹组患者的发病平均年龄比非重症药疹组高。2、我院住院药疹患者中,以抗生素、抗癫痫药及抗痛风类药物为主要致敏药物。3、我院住院药疹患者中,EE、SJS、DIHS三种药疹最常见,约一半属于病情严重的重症类药疹。4.DIHS常见的致敏药物依次为抗生素、抗癫痫药及非甾体类药物；重症药疹常见致敏药物分别为抗癫痫药、抗痛风药及抗生素；非重症药疹最常见致敏药物为抗生素。5、DIHS组、重症药疹组、非重症药疹组在潜伏期、发热、肝功能损害等方面具有显著差异；重症药疹组在肾功能损害发生率上比DIHS组及非重症药疹组高,DIHS组与非重症药疹组无显著差异。6、住院药疹患者,EOS升高最常见于DIHS,其次为重症药疹及非重症药疹。7、EOS升高组药疹患者的潜伏期时间延长,发热、肝功能损害的发生率增高,病情控制所需时间增加,但对肾功能无明显影响。8、DIHS组、重症药疹组、非重症药疹组及对照组HHV-6感染阳性率分别为33.3%、21.6%、5.3%、0%。DIHS组阳性率与重症药疹组无明显差异(P=0.295),DIHS组与重症药疹组阳性率明显高于非重症药疹组及对照组,非重症药疹组阳性率与正常对照组相比无明显差异(P=0.311)。9、DIHS组、重症药疹组、非重症药疹组及对照组HHV-7感染阳性率分别为33.3%、31.4%、8%、6.1%。DIHS组阳性率与重症药疹组无明显差异(P=0.871),DIHS组与重症药疹组阳性率明显高于非重症药疹组及对照组,非重症药疹组阳性率与正常对照组相比无明显差异(P=1.000)。10、DIHS组、重症药疹组、非重症药疹组及对照组EBV感染阳性率分别为42.9%、27.5%、12%、3%。DIHS组阳性率与重症药疹组无明显差异(P=0.203),DIHS组与重症药疹组阳性率明显高于非重症药疹组及对照组,非重症药疹组阳性率与正常对照组相比无明显差异(P=0.262)。11、DIHS组、重症药疹组、非重症药疹组及对照组CMV感染阳性率分别为42.9%、23.5%、12%、9.1%。DIHS组阳性率与重症药疹组无明显差异(P=0.101),DIHS组与重症药疹组阳性率明显高于非重症药疹组及对照组,非重症药疹组阳性率与正常对照组相比无明显差异(P=0.088)。12、DIHS组、重症药疹组、非重症药疹组及对照组PVB19感染阳性率分别为0%、5.9%、4%、6.1%。PVB19感染阳性率对比组间均无差别。13、DIHS组、重症药疹组、非重症药疹组及正常对照组多重感染率分别为38.1%、27.5%、3%、6.1%。DIHS组阳性率与重症药疹组无明显差异(P=0.268),DIHS组与重症药疹组阳性率明显高于非重症药疹组及正常对照组,非重症药疹组阳性率与正常对照组相比无明显差异(P=0.850)。14、病毒感染药疹患者与非病毒感染药疹患者对比,EOS增高发生率显著增高(X2=6.392,P=0.011)。结论：本组病例中：抗生素、抗癫痫药及抗痛风类药物是引起药疹主要的致敏药物,DIHS常见致敏药物为抗生素、抗癫痫药及非甾体类药物,重症药疹常见致敏药物为抗癫痫药、抗痛风药及抗生素。DIHS具有明显的发热、肝功能损害,但肾功能损害较少。EOS升高,药疹患者潜伏期时间延长,发热、肝功能损害的发生率增高,病情控制时间更长,但对肾功能无明显影响。DIHS及重症药疹的发病与HHV-6、HHV-7、EBV、CMV感染均有关,与PVB19感染无关,病毒感染可能是药疹病情加重的主要原因。疱疹病毒的再激活可能与药疹患者EOS的升高相关。图5幅,表15个,参考文献66篇。
[Abstract]:Objective: To collect and analyze the clinical data of 147 patients with drug-related dermatitis and to observe the infection of human herpesvirus (HHV-6, HHV-7, EBV, CMV) and parvovirus (PVB19) in the patients with drug dermatitis. Method: 1. Collect the serum of the patients with drug-dermatitis and the normal controls in our hospital from September 2010 to March 2013; 2. HHV-6, HHV-7, EBV, CMV and PVB19 were detected by enzyme-linked immunosorbent assay. 4. The age, sex, type of drug eruption, sensitizing drug and clinical features of the patients with drug dermatitis were analyzed, and the viral infection and some clinical data were integrated. The results were as follows:1. There was no significant difference in the sex of the patients with severe drug eruption, the average age of the patients with severe drug eruption was higher than that of the non-severe drug eruption group, and the average age of the patients in the severe drug eruption group was higher than that of the non-severe drug eruption group. 3. The most common drug eruption of EE, SJS and DIHS in the patients with drug eruption in our hospital, about half of them belong to the severe type of drug eruption. Antiepileptic drugs, anti-gout drugs and antibiotics; the most common sensitizers for non-severe drug eruption were antibiotics.5. DHS group, severe drug eruption group, non-severe drug eruption group had significant effects on latent period, fever, liver function damage, etc. There was no significant difference in the incidence of renal function in the severe drug eruption group than in the DHS group and the non-severe drug eruption group.6. The increase of EOS in the patients with drug eruption in the hospital was most common in the DIHS, followed by severe drug eruption and non-intensive medicine. The positive rate of HHV-6 infection in the 8, DIHS group, severe drug eruption group, non-severe drug eruption group and control group was 33.3% and 21 respectively. 6%, 5.3%,0%. The positive rate of the DIHS group and the severe drug eruption group was not significantly different (P = 0.295), the positive rate of the DIHS group and the severe drug eruption group was significantly higher than that of the non-severe drug eruption group and the control group, and the positive rate of the non-severe drug eruption group was not significantly different from the normal control group (P = 0.311). The positive rates of HHV-7 were 33.3%, 31.4%,8% and 6.1%, respectively. The positive rate of EBV infection in the control group and non-severe drug eruption group was 42.9%, 27.5%,12% and 3%, respectively, compared with the normal control group (P = 1.000). The positive rate of the non-severe drug eruption group was significantly higher than that of the control group (P = 0.262). The positive rate of the non-severe drug eruption group and the control group was 42.9% and 23.5%, respectively. The positive rate of DIHS group and severe drug eruption group was significantly higher than that of non-severe drug eruption group (P = 0.101), and the positive rate of non-severe drug eruption group was significantly higher than that of control group (P = 0.088). The positive rate of PVB19 infection was 0%, 5.9%,4% and 6.1%, respectively. The positive rate of DHS group and severe drug eruption group was significantly higher than that of non-severe drug eruption group (P = 0.268), and the positive rate of non-severe drug eruption group was significantly higher than that of normal control group (P = 0.850). .14. The incidence of EOS increased significantly (X2 = 6.392, P = 0.0) compared with non-viral-viral-rash patients. 11) Conclusion: In this group, antibiotics, antiepileptic drugs and anti-gout drugs are the main sensitizers for drug eruption. The common sensitizing drugs of DIHS are antibiotics, antiepileptic drugs and non-antiepileptic drugs, and the common sensitizers for severe drug eruption are antiepileptic drugs and anti-gout. The medicine and the antibiotic. The DIHS has obvious fever, liver function damage, but the kidney function Has less damage to EOS, prolonged incubation period of patients with drug eruption, higher incidence of fever and liver function damage, and longer disease control time, but has no effect on renal function. No significant effect. The incidence of DIHS and severe drug eruption was related to HHV-6, HHV-7, EBV, and CMV infection. The main reason for this is that the reactivation of herpes virus may be related to the EOS of the patient with drug eruption The elevation of the figure is related. Figure 5, Table 15, Reference
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.25

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