[1]唐鲜艳,李瑛,马凯,等.儿童药物超敏反应综合征26例临床分析[J].中国皮肤性病学杂志,2019,(06):679-683.[doi:10.13735/j.cjdv.1001-7089.201806148]
 TANG Xianyan,LI Ying,MA Kai,et al.Clinical Analysis of Drug-induced Hypersensitivity Syndrome in 26 Children[J].The Chinese Journal of Dermatovenereology,2019,(06):679-683.[doi:10.13735/j.cjdv.1001-7089.201806148]
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儿童药物超敏反应综合征26例临床分析
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《中国皮肤性病学杂志》[ISSN:1001-7089/CN:61-1197/R]

卷:
期数:
2019年06期
页码:
679-683
栏目:
临床经验
出版日期:
2019-05-16

文章信息/Info

Title:
Clinical Analysis of Drug-induced Hypersensitivity Syndrome in 26 Children
文章编号:
1001-7089(2019)06-0679-05
作者:
唐鲜艳李瑛马凯李小青
西安交通大学医学院附属儿童医院风湿免疫科,陕西 西安 710002
Author(s):
TANG XianyanLI YingMA KaiLI Xiaoqing
University,Xi'an 710002,China)
关键词:
儿童 药物超敏反应 临床分析
Keywords:
Children Drug-induced hypersensitivity Clinical analysis
分类号:
R 758.25
DOI:
10.13735/j.cjdv.1001-7089.201806148
文献标志码:
B
摘要:
目的 分析儿童药物超敏反应综合征的临床表现、实验室检查及治疗措施。方法 回顾分析2015年1月-2018年3月西安交通大学医学院附属儿童医院免疫科住院的26例DIHS患儿的临床表现、实验室检查、治疗方案及预后。结果 男17例,女9例,年龄1个月~13岁。怀疑药物:11例为抗生素,8例为抗癫痫药,3例为非甾体抗炎药。所有患儿均伴有发热、皮疹,15例表现为麻疹样红斑,5例表现为多形红斑样皮疹。肝功能损伤25例,10例谷氨酸-丙酮酸转氨酶升高10倍以上,肺部感染16例,神经系统损害3例。10例浅表淋巴结肿大,11例外周血嗜酸性粒细胞增多大于1.5×109/L,20例异常淋巴细胞计数大于5%。确诊后均予停用可疑致敏药物,静脉应用糖皮质激素联合免疫球蛋白,同时给予黏膜护理及脏器功能保护; 2例联合血液净化,4例加用口服环孢素。所有患者均临床治愈或好转,无死亡病例。结论 儿童DIHS常见致敏药物主要为抗生素及抗癫痫药物。一经确诊积极给予糖皮质激素联合免疫球蛋白治疗,重症者联合血浆置换或免疫抑制剂可达到较好临床效果。
Abstract:
Objective To analyze the clinical manifestations,laboratory data and treatment about drug-induced hypersensitivity syndrome(DIHS).Methods Twenty-six patients with DIHS,who hospitalized in Department of Immunology,Children's Hospital Affiliated Medical College of Xi'an Jiaotong University from Jan.2015 to Mar.2018,were collected.Their clinical manifestations,laboratory data,treatment and prognosis were retrospectively analyzed.Results Among all 26 cases,there were 17 males and 9 females ranging from one month to 13 years old.Drugs,which suspiciously induced hypersensitivity syndrome,were antibiotics 11 cases,antiepileptic drugs 8 cases,and non-steroidal anti-inflammatory drugs 4 cases.All patients were manifested persistent fever and allergic rash,while it was showed erythema morbilliform in 15 cases and polymorphic erythematoid rash in five cases.Twenty-five out of 26 cases were found liver lesions,even in 10 out of 25 cases their transaminase significantly increased more 10 times than normal.Furthermore,16 out of 26 patients combined with pulmonary infection,3 patients with nervous system damage,and 10 patients with superficial lymphadenopathy. Eosinophilia count of peripheral blood was increased more than 1.5×109/L in 11 cases,while abnormal lymphocyte count was exceeded 5% in 20 cases.Once patients were diagnosed DIHS,all the suspected drugs were discontinued as soon as possible.Then,patients were immediately administrated by intravenous methylprednisolone and intravenous immune globulin(IVIG).Meanwhile it was necessary to take care mucosal and organ function protection.In addition,2 case were performed plasma exchange,and 4 cases were taken oral ciclosporin.All patients were clinically cured or improved at discharge without death. Conclusion The common sensitizing drugs of DIHS in children are mainly antibiotics and antiepileptic drugs.Once DIHS is diagnosed,using glucocorticoid combined with IVIG actively.The combination of plasma exchange and immunosuppressant can achieve good clinical effect in severe patients.

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备注/Memo

备注/Memo:
[作者单位] 西安交通大学医学院附属儿童医院风湿免疫科,陕西 西安 710002
[通讯作者] 李小青,E-mail:xa_lxq@163.com
更新日期/Last Update: 2019-05-16