【摘要】：目的：收集并分析147例住院的藥物性皮炎患者臨床資料,觀察藥物性皮炎患者人皰疹病毒(HHV-6、HHV-7、EBV、CMV)及細(xì)小病毒(PVB19)的感染狀況。 方法：1.收集2010年9月到2013年3月入住我院的藥物性皮炎患者及正常對照者的血清；2.采用酶聯(lián)免疫吸附法檢測血清中HHV-6、 HHV-7、EBV、CMV及PVB19抗體；3分析藥物超敏反應(yīng)綜合征(DIHS)患者、重癥藥疹患者、非重癥藥疹患者及正常人病毒感染的差異；4.對藥物性皮炎患者的年齡、性別、藥疹類型、致敏藥物、臨床特點等與病毒感染進(jìn)行相關(guān)分析,并將病毒感染與部分臨床資料進(jìn)行綜合分析。 結(jié)果：1、DIHS組、重癥藥疹組、非重癥藥疹組患者性別無顯著差異；重癥藥疹組患者的發(fā)病平均年齡比非重癥藥疹組高。2、我院住院藥疹患者中,以抗生素、抗癲癇藥及抗痛風(fēng)類藥物為主要致敏藥物。3、我院住院藥疹患者中,EE、SJS、DIHS三種藥疹最常見,約一半屬于病情嚴(yán)重的重癥類藥疹。4.DIHS常見的致敏藥物依次為抗生素、抗癲癇藥及非甾體類藥物；重癥藥疹常見致敏藥物分別為抗癲癇藥、抗痛風(fēng)藥及抗生素；非重癥藥疹最常見致敏藥物為抗生素。5、DIHS組、重癥藥疹組、非重癥藥疹組在潛伏期、發(fā)熱、肝功能損害等方面具有顯著差異；重癥藥疹組在腎功能損害發(fā)生率上比DIHS組及非重癥藥疹組高,DIHS組與非重癥藥疹組無顯著差異。6、住院藥疹患者,EOS升高最常見于DIHS,其次為重癥藥疹及非重癥藥疹。7、EOS升高組藥疹患者的潛伏期時間延長,發(fā)熱、肝功能損害的發(fā)生率增高,病情控制所需時間增加,但對腎功能無明顯影響。8、DIHS組、重癥藥疹組、非重癥藥疹組及對照組HHV-6感染陽性率分別為33.3%、21.6%、5.3%、0%。DIHS組陽性率與重癥藥疹組無明顯差異(P=0.295),DIHS組與重癥藥疹組陽性率明顯高于非重癥藥疹組及對照組,非重癥藥疹組陽性率與正常對照組相比無明顯差異(P=0.311)。9、DIHS組、重癥藥疹組、非重癥藥疹組及對照組HHV-7感染陽性率分別為33.3%、31.4%、8%、6.1%。DIHS組陽性率與重癥藥疹組無明顯差異(P=0.871),DIHS組與重癥藥疹組陽性率明顯高于非重癥藥疹組及對照組,非重癥藥疹組陽性率與正常對照組相比無明顯差異(P=1.000)。10、DIHS組、重癥藥疹組、非重癥藥疹組及對照組EBV感染陽性率分別為42.9%、27.5%、12%、3%。DIHS組陽性率與重癥藥疹組無明顯差異(P=0.203),DIHS組與重癥藥疹組陽性率明顯高于非重癥藥疹組及對照組,非重癥藥疹組陽性率與正常對照組相比無明顯差異(P=0.262)。11、DIHS組、重癥藥疹組、非重癥藥疹組及對照組CMV感染陽性率分別為42.9%、23.5%、12%、9.1%。DIHS組陽性率與重癥藥疹組無明顯差異(P=0.101),DIHS組與重癥藥疹組陽性率明顯高于非重癥藥疹組及對照組,非重癥藥疹組陽性率與正常對照組相比無明顯差異(P=0.088)。12、DIHS組、重癥藥疹組、非重癥藥疹組及對照組PVB19感染陽性率分別為0%、5.9%、4%、6.1%。PVB19感染陽性率對比組間均無差別。13、DIHS組、重癥藥疹組、非重癥藥疹組及正常對照組多重感染率分別為38.1%、27.5%、3%、6.1%。DIHS組陽性率與重癥藥疹組無明顯差異(P=0.268),DIHS組與重癥藥疹組陽性率明顯高于非重癥藥疹組及正常對照組,非重癥藥疹組陽性率與正常對照組相比無明顯差異(P=0.850)。14、病毒感染藥疹患者與非病毒感染藥疹患者對比,EOS增高發(fā)生率顯著增高(X2=6.392,P=0.011)。 結(jié)論：本組病例中：抗生素、抗癲癇藥及抗痛風(fēng)類藥物是引起藥疹主要的致敏藥物,DIHS常見致敏藥物為抗生素、抗癲癇藥及非甾體類藥物,重癥藥疹常見致敏藥物為抗癲癇藥、抗痛風(fēng)藥及抗生素。DIHS具有明顯的發(fā)熱、肝功能損害,但腎功能損害較少。EOS升高,藥疹患者潛伏期時間延長,發(fā)熱、肝功能損害的發(fā)生率增高,病情控制時間更長,但對腎功能無明顯影響。DIHS及重癥藥疹的發(fā)病與HHV-6、HHV-7、EBV、CMV感染均有關(guān),與PVB19感染無關(guān),病毒感染可能是藥疹病情加重的主要原因。皰疹病毒的再激活可能與藥疹患者EOS的升高相關(guān)。圖5幅,表15個,參考文獻(xiàn)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
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R758.25

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 楊婷婷;朱桂芝;陳官芝;羅兵;;藥疹病人EB病毒和人皰疹病毒6型感染檢測[J];青島大學(xué)醫(yī)學(xué)院學(xué)報;2009年04期

2 石平榮;李凱;段逸群;周小勇;;藥物超敏反應(yīng)綜合征發(fā)病機(jī)制及治療的研究進(jìn)展[J];國際皮膚性病學(xué)雜志;2006年02期

3 申杰;周文明;;病毒感染與藥物超敏反應(yīng)綜合征研究進(jìn)展[J];安徽醫(yī)藥;2012年09期

4 謝淑霞,賴維,陸春,蘇向陽,萬苗堅,黃懷球;202例藥疹的臨床分析[J];臨床皮膚科雜志;2000年02期

5 張超英;518例住院藥疹患者致病藥物臨床分析[J];臨床皮膚科雜志;2002年01期

6 高天文,廖文俊,李珍妮,李巍,劉玉峰;血漿輸注及血漿置換治療重癥皮膚病[J];臨床皮膚科雜志;2002年05期

7 丁楊峰;談怡雯;章偉;;藥疹96例臨床分析[J];臨床皮膚科雜志;2006年08期

8 馮歡;馮信忠;;藥物超敏綜合征[J];臨床皮膚科雜志;2008年09期

9 史玉玲;高飛;衛(wèi)威;;168例藥疹臨床分析[J];臨床皮膚科雜志;2008年12期

10 李和蓮,陳志強(qiáng),陳祥生,余美文,林彤;重癥藥疹68例臨床分析[J];中國麻風(fēng)皮膚病雜志;2001年03期

，

本文編號：2489990