【摘要】：目的:通過分析107例重癥藥疹患者臨床資料,探討福建地區(qū)重癥藥疹的流行及臨床特點。方法:本次病例來源為2010-2012年期間福建醫(yī)科大學附屬第一醫(yī)院、泉州市第一醫(yī)院、廈門市第一醫(yī)院收治的符合重癥藥疹診斷的107例住院患者,所有研究對象均符合診斷標準、納入標準。對重癥藥疹分型、致敏藥物、性別、年齡、潛伏期進行描述,并運用非參數(shù)檢驗的方法對不同致敏藥物所致SCDR患者性別和年齡,不同類型SCDR患者的相關實驗室檢查結果進行獨立樣本檢驗,同時運用雙變量方法分析相關實驗室檢查結果與控制激素劑量的相關性,最后運用多分類等級logistic方法分析多因素與預后的關系。結果:2010年-2012年期間福建地區(qū)三所醫(yī)院住院重癥藥疹男性患者人數(shù)略多于女性患者,其男女比例為1.18:1,且三年來發(fā)病人數(shù)逐年增長,其中以SJS患者最為多見。福建地區(qū)導致重癥藥疹的致敏藥物以抗生素類藥物最為常見,其他依次為抗癲癇及精神類藥物、別嘌呤醇、中藥及成藥類、解熱鎮(zhèn)痛藥。而在不同致敏藥物所致的重癥藥疹中其性別分布無顯著差異(P0.05),而別嘌呤醇所致重癥藥疹患者的平均年齡較其他患者大,具有統(tǒng)計學差異(P0.05)。在三型重癥藥疹中以DIHS的潛伏期最長。在重癥藥疹患者中以AST升高最為常見。在三種類型藥疹中ALT、E、WBC在DIHS中異常較其他類型藥疹更為明顯,其差異具有統(tǒng)計學意義(P0.05),而NE%升高在TEN較其他兩種類型重癥藥疹差異更為明顯(P0.05)。而對于不同藥物所致的重癥藥疹,BUN、肌酐在別嘌呤醇中的升高較其他藥物所致重癥藥疹更為明顯(P0.05)。而發(fā)熱、NE%、AST、ALT、粘膜受累情況與控制激素劑量均成正比(R值0),且具有明顯統(tǒng)計學意義(P0.05)。而性別、年齡、肌酐、尿素氮與控制激素劑量之間相關性沒有統(tǒng)計學意義(P0.05)。對于預后來說,年齡、BUN均與其有關,年齡越大、BUN水平越高,預后越差。結論:1.福建地區(qū)重癥藥疹的發(fā)病呈上升趨勢,其主要致敏藥物為抗生素類、抗癲癇及精神類、別嘌呤醇。2.別嘌呤醇所致的重癥藥疹其患病年齡較其他藥物所致重癥藥疹更大。3.在重癥藥疹中AST升高最為常見,在DIHS患者中ALT、E、WBC異常較其他類型藥疹更為明顯,而NE%升高在TEN較其他兩種類型重癥藥疹更為明顯。4別嘌呤醇所致重癥藥疹患者其腎功能異常較其他藥物所致的重癥藥疹更為常見。5.年齡越大,BUN值越高,預后越差。
[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.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R758.25

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