成人药物超敏反应综合征临床特征及预后的单中心分析

A single-center analysis of clinical characteristics and prognosis of drug-induced hypersensitivity syndrome in adults

  • 摘要: 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 本文为单中心回顾性病例系列研究。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(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21.0(IQR:11.0 ~ 30.0) 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%),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%)、肺炎支原体阳性4 例(11.8%)、柯萨奇病毒阳性1例(2.9%)。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,较长的潜伏期可能是DIHS复发的危险因素或相关特征。结论 本中心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,但抗病毒价值尚需验证;激素强调个体化减量。

     

    Abstract: 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 This was a single-center, retrospective case series study. 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 21.0 (IQR, 11.0 - 30.0). 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 12 cases (35.3%) induced by antibacterial agents, 7 cases (20.6%) by traditional Chinese medicine, 5 cases (14.7%) by anti-gout drugs, and 4 cases (11.8%) by anti-epileptic drugs; in addition, 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%), mycoplasma pneumoniae positive in 4 cases (11.8%), and Coxsackievirus positive in 1 case (2.9%). All patients received glucocorticoid therapy, and nearly half (16 cases, 47.1%) received combined treatment with intravenous immunoglobulin. All 34 patients achieved shortterm 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), indicating that a prolonged incubation period may be a risk factor or associated characteristic for DIHS recurrence. Conclusion DIHS cases in our center are characterized by a relatively long latency period. Antibacterials and 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 yields definite therapeutic efficacy. Viral infections may be associated with disease relapse, although the value of antiviral therapy remains to be validated. Individualized tapering of corticosteroids is emphasized.

     

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