本文選題：藥疹 + 致敏藥物　； 參考：《河北醫(yī)科大學(xué)》2010年碩士論文

【摘要】： 目的:藥物通過注射內(nèi)服吸入等途徑進入人體后引起的皮膚粘膜反應(yīng)稱為藥疹。藥物引起的不良反應(yīng)非常復(fù)雜,大致可以分藥物過量不耐受性特發(fā)性副作用繼發(fā)作用及過敏反應(yīng)等,藥疹是過敏反應(yīng)最常見的類型。在臨床上應(yīng)用多種藥物進行治療的病人發(fā)生藥物過敏,當(dāng)這種病人不能停藥時,可以通過動物實驗來檢測此種病人對何種藥物過敏,從而停止該藥物,而不停用其他藥物,從而不延誤病人的治療。但藥疹的實驗分為皮膚實驗和實驗室試驗,兩者都不完善。本實驗就是通過已明確何種藥物致敏的患者的血清注射到動物局部,通過注射后引起的全身反應(yīng)和局部反應(yīng)為動物實驗檢測藥疹患者致敏藥物提供參考。本實驗所用動物是小鼠,通過小鼠局部注射后引起的全身反應(yīng)和局部反應(yīng)來完成本實驗,為臨床提供參考以克服傳統(tǒng)激發(fā)試驗所帶來的危險性。 方法:本實驗是通過藥疹患者的血清注入小鼠背部局部皮下,24,48小時后局部注入藥疹患者的致敏藥物,試驗組小鼠出現(xiàn)全身反應(yīng)和局部反應(yīng)的陽性率較高,而對照組陽性率較低。通過試驗組和對照組比較來為動物實驗檢測藥疹患者何種藥物致敏提供參考。藥疹患者15例均來自河北醫(yī)科大學(xué)第三醫(yī)院皮膚科,時間是2009年3月到2009年12月。這些藥疹患者均經(jīng)過詳細詢問用藥史,并且反復(fù)發(fā)生該藥物過敏。其中有5例是來自其他科室用藥過程中發(fā)生過敏并且激發(fā)試驗也證明對此藥過敏。其中有2例司帕沙星過敏,2例左氧氟沙星過敏,1例二甲雙呱過敏,1例青霉素類過敏,1例磺胺藥物過敏,8例解熱鎮(zhèn)痛藥過敏。小鼠均來自河北醫(yī)科大學(xué)動物實驗中心,小鼠隨機分組進行背部局部皮下注射,對照組是采用藥疹患者血清注入小鼠背部局部皮下,24,48小時后局部再注射生理鹽水。觀察局部反應(yīng)和全身反應(yīng),進行對照組和試驗組對比。試驗組和對照組均取局部組織進行普通HE染色,再進行鏡檢。最后對局部反應(yīng)和全身反應(yīng)進行評分。 過敏反應(yīng)癥狀:0正常,1躁動,2豎毛,3顫抖,4搔鼻,5噴嚏,6咳嗽,7呼吸急促,8排尿,9排糞,10流淚,11呼吸困難,12哮鳴音,13紫癜,14步態(tài)不穩(wěn),15跳躍,16喘息,17痙攣,18旋轉(zhuǎn),19潮式呼吸,20死亡。 全身反應(yīng)評價標(biāo)準:過敏反應(yīng)陰性(-) 0分;弱陽性(+) 1-4分;陽性(++) 5-10分;強陽性(+++) 11-19分;極強陽性(++++) 20分 本次實驗用90只小鼠進行試驗,每次6只,每次分2組,每組3只,分對照組和試驗組,小鼠自由分配。共進行15次試驗。 結(jié)果:試驗組陽性率較高,甚至有小鼠出現(xiàn)死亡的極強陽性的表現(xiàn),而對照組陽性率較低。 試驗組陽性例數(shù):7例躁動,3例呼吸急促,4例顫抖,4例排尿糞,6例步態(tài)不穩(wěn),5例旋轉(zhuǎn),2例噴嚏,2例死亡。試驗組陰性例數(shù):12例。 對照組陽性例數(shù):1例躁動,1例旋轉(zhuǎn),1例顫抖,2例呼吸困難。對照組陰性例數(shù):40例。 結(jié)論:藥疹病人血清注入小鼠背部局部皮下,24,48小時后再注入生理鹽水,這對照組45例中5例陽性變化,病理無變化,而試驗組為小鼠背部局部皮下注入藥疹患者血清,24,48小時后再注入藥疹患者致敏藥物,這試驗組45例中有33例陽性變化,病理有大量的炎細胞。通過試驗組和對照組的比較,由于n40且所有T5(T為理論數(shù),n為例數(shù))用普通卡方檢驗P0.01有統(tǒng)計學(xué)意義,說明試驗組和對照組出現(xiàn)差別,試驗組陽性率高于對照組。臨床上如果懷疑某患者對某藥過敏,可以通過藥疹患者血清注入小鼠背部局部皮下,24,48小時后再注入懷疑的致敏藥物,如果出現(xiàn)過敏反應(yīng)癥狀并且陽性率較高,,病理出現(xiàn)大量炎細胞,則該患者可能對該藥過敏,可以停用該藥物。
[Abstract]:Objective: drug rash is called drug rash caused by drug injection, inhalation and so on. The adverse reactions caused by drugs are very complex, generally can be divided into drug overdoses, intolerance, side effects, secondary and anaphylaxis, and drug rash is the most common type of anaphylaxis. A variety of clinical applications are used in clinical practice. Drugs for the treatment of patients with drug allergy, when the patient can not stop drugs, can be tested by animal experiments to determine the patient's drug allergy, and then stop the drug, without stopping the use of other drugs, and not delay the patient's treatment. But the drug rash experiment is divided into skin tests and laboratory tests, both are imperfect. The experiment is to provide a reference for the detection of allergic drugs in patients with drug eruptions by injecting the serum of the patients with specific drug sensitization to the animal's part, through the systemic and local reactions after the injection. The animals used in this experiment are completed by the systemic and local reactions caused by the local injection of the mice. This experiment provides a reference for clinic to overcome the danger of traditional stimulation test.
Methods: this experiment was injected into the local subcutaneous of the back of the mice by the serum of the drug eruption patients, and the sensitized drugs were injected locally after 24,48 hours. The positive rate of the whole body reaction and the local reaction in the experimental group was higher, and the positive rate of the control group was low. 15 cases of drug eruptions were from the Department of dermatology at the Third Hospital of Hebei Medical University from March 2009 to December 2009. The drug rash patients were all inquired about the history of drug use and repeated the drug allergy. Of these, 5 were allergic and provocative tests from other departments. There were 2 cases of sparfloxacin allergy, 2 cases of levofloxacin allergy, 1 cases of two a double croak, 1 cases of penicillin allergy, 1 case of sulfanilamide allergy, and 8 cases of antipyretic and analgesic drug allergy. All of the mice were from the Hebei Medical University animal experiment center, the mice were randomly divided into subcutaneous injection in the back, and the control group was used drug rash. The patient's serum was injected into the subcutaneous part of the mouse's back, and the saline was injected locally after 24,48 hours. The local reaction and the whole body reaction were observed. The control group and the control group were compared with the experimental group. The experimental group and the control group were taken local tissue for general HE staining, and then the microscopic examination was performed. Finally, the local reaction and the whole body reaction were evaluated.
Allergic reaction symptoms: 0 normal, 1 restlessness, 2 erect hair, 3 tremors, 4 scratches, 5 sneezes, 6 coughs, 7 breaths, 8 urination, 9 dung, 10 tears, 11 breathing difficulties, 12 wheezing, 13 purpura, unstable gait, wheezing, spastic spasm, tidal breathing, death.
The general reaction evaluation criteria: allergic reaction negative (-) 0 points; weak positive (+) 1-4 points; positive (+ +) 5-10 points; strong positive (+ + +) 11-19 points; extremely strong (+ + + +) 20 points.
In this experiment, 90 mice were tested, 6 each time, each time was divided into 2 groups, each group 3, divided into the control group and the experimental group, the mice were allocated freely. Altogether 15 tests were carried out.
Results: the positive rate of the test group was higher, and even the death rate of the mice was very strong, while the positive rate of the control group was low.
The number of positive cases in the test group: 7 cases of restlessness, 3 cases of shortness of breath, 4 cases of trembling, 4 cases of urination, 6 cases of gait instability, 5 cases of rotation, 2 cases of sneezing, 2 cases of death. The number of negative cases in the test group: 12 cases.
Control group positive cases: 1 cases of restlessness, 1 cases of rotation, 1 cases of tremor, 2 cases of dyspnea. Control group negative cases: 40 cases.
Conclusion: the sera of the patients with drug eruption were injected into the subcutaneous part of the mouse's back, and then injected with saline after 24,48 hours. There were 5 positive changes in the 45 cases of the control group, and the pathological changes were not changed. The experimental group injected the serums of the local subcutaneous injection of drug eruptions in the mice back, and then the drug erupted after 24,48 hours, and there were 33 positive changes in the test group of 45 cases. There was a large number of inflammatory cells in the pathology. Through the comparison between the experimental group and the control group, the test group was significantly higher than the control group because of N40 and all T5 (T theory number, n as the number of cases) with ordinary chi square test, indicating the difference between the test group and the control group, and the positive rate of the test group was higher than that of the control group. When the serum is injected into the subcutaneous part of the mouse's back, the suspected sensitizing drug is injected after 24,48 hours. If the allergic reaction is found and the positive rate is high, a large number of inflammatory cells are found in the pathology, then the patient may be allergic to the drug, and the drug can be discontinued.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R758.25

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本文編號：1918491