抗癫痫药高敏综合征临床分析及相关文献复习
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摘要
目的:分析抗癫痫药高敏综合征(AHS)的特点,提高医务人员对此病的认识。方法:回顾性分析1例经临床诊断的AHS患儿的临床资料。结果:患儿因免疫性脑炎、癫痫持续状态服用丙戊酸钠口服液每次6 mL,每日2次,苯巴比妥片每次45 mg,每日2次,托吡酯片每次31.25 mg,每日2次。1个月后出现持续高热,周身严重斑丘疹、大疱疹,伴有瘙痒、皮肤剥脱,呼吸系统、肾脏、心肌损害,诊断为AHS,经相应治疗后病情逐渐好转。结论:AHS是一种特异质反应,其发病机制尚不清楚。用药史、临床表现、实验室检查是鉴别诊断此病的重要依据。早期识别、诊断,及时停用致敏药物并治疗是避免此病出现致命性损害的关键。
Objective: To analyze the characteristics of antiepileptic drug hypersensitivity syndrome(AHS) and enhance medical staff′s awareness of this disease. Methods: Retrospectively analysis the clinical data of a clinically diagnosed AHS child. Results: The child was given sodium valproate oral solution 6 mL/time, 2 times/day. Phenobarbital tablets 45 mg/time, 2 times/day. Topiramate tablets 31.25 mg/time, 2 times/day. Due to autoimmune encephalitis and status epilepticus. One month later, the patient occurred persistent high fever, severe maculopapular rash, herpes, accompanied by itching, skin exfoliation, and respiratory system, kidney, myocardial damage, and diagnosed as AHS. After corresponding treatment, the patient′s condition improved. Conclusion: AHS is an idiosyncratic reaction,the pathogenesis is still unclear.Medication history, clinical manifestations, laboratory examinations are important basis for the differential diagnosis.Early identification, diagnosis,timely discontinuing of the suspected drugs and treatment are the keys to avoid fatal damage.
Objective: To analyze the characteristics of antiepileptic drug hypersensitivity syndrome(AHS) and enhance medical staff′s awareness of this disease. Methods: Retrospectively analysis the clinical data of a clinically diagnosed AHS child. Results: The child was given sodium valproate oral solution 6 mL/time, 2 times/day. Phenobarbital tablets 45 mg/time, 2 times/day. Topiramate tablets 31.25 mg/time, 2 times/day. Due to autoimmune encephalitis and status epilepticus. One month later, the patient occurred persistent high fever, severe maculopapular rash, herpes, accompanied by itching, skin exfoliation, and respiratory system, kidney, myocardial damage, and diagnosed as AHS. After corresponding treatment, the patient′s condition improved. Conclusion: AHS is an idiosyncratic reaction,the pathogenesis is still unclear.Medication history, clinical manifestations, laboratory examinations are important basis for the differential diagnosis.Early identification, diagnosis,timely discontinuing of the suspected drugs and treatment are the keys to avoid fatal damage.
引文
[1] 方圣博,张晓荧,张欣,等.拉莫三嗪致儿童高敏综合征1例[J].药物流行病学杂志,2018,27(3):213-214.
[2] 辜蕊洁,马秀伟,封志纯.丙戊酸钠致抗癫痫药高敏综合征1例[J].儿科药学杂志,2012,18(12):62-63.
[3] 韩燕,庄兰春,郭丽娟.德巴金引起抗癫痫药高敏综合征(AHS)1例报道[J].中国现代药物应用,2009,3(8):161.
[4] Knowles SR,Dewhurst N,Shear NH.Anticonvulsant hypersensitivity syndrome:an update[J].Expert Opin Drug Saf,2012,11(5):767-778.
[5] 王宁,艾戎,金皎.小儿抗癫痫药高敏综合征1例[J].中华妇幼临床医学杂志,2009,5(4):90-91.
[6] Elzagallaai AA,Garciabournissen F,Finkelstein Y,et al.Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han Chinese child with a positive HLA-B*1502 and negative in vitro toxicity assays:evidence for different pathophysiological mechanisms[J].Popul Ther Clin Pharmacol,2011,18(1):e1-e9.
[7] Dredge DC,Parsons EC,Carter LP,et al.Anticonvulsant hypersensitivity syndrome treated with intravenous immunoglobulin[J].Pediatr Neurol,2010,43(1):65-69.
[8] 侯蕴祈,石海琴,杨红姬.HLA-B*1502表达与AEDs致敏相关性的临床研究[J].中风与神经疾病杂志,2017,34(12):1090-1092.
[9] 黄亚莉,任惠.芳香族抗癫痫药物所致严重皮肤不良反应的研究进展[J].癫痫杂志,2017,3(4):325-328.
[10] Grover S,Kukreti R.HLA alleles and hypersensitivity to carbamazepine:an updated systematic review with meta-analysis[J].Pharmacogenetics & Genomics,2014,24(2):104-112.
[11] Trivedi BS,Darji NH,Malhotra SD,et al.Antiepileptic drugs-induced Stevens-Johnson syndrome:a case series[J].J Basic Clin Pharm,2016,8(1):42-44.
[12] Wang XQ,Lv B,Wang HF,et al.Lamotrigine induced DIHS /DRESS:Manifestations,treatment,and outcome in 57 patients[J].Clinical Neurology and Neurosurgery,2015,138(11):1-7.
[13] 中华医学会.临床诊疗指南-癫痫病分册[M].北京:人民卫生出版社,2007,51-52.
[14] 梅昕,沈继斌,刘立民.抗癫痫药物诱发高敏综合征1例临床分析[J].中国皮肤性病学杂志,2015,29(3):265-266,287.
[15] 余永林,夏哲智.儿童抗癫痫药过敏反应36例[J].中国现代药物应用,2009,3(20):130-132.
[2] 辜蕊洁,马秀伟,封志纯.丙戊酸钠致抗癫痫药高敏综合征1例[J].儿科药学杂志,2012,18(12):62-63.
[3] 韩燕,庄兰春,郭丽娟.德巴金引起抗癫痫药高敏综合征(AHS)1例报道[J].中国现代药物应用,2009,3(8):161.
[4] Knowles SR,Dewhurst N,Shear NH.Anticonvulsant hypersensitivity syndrome:an update[J].Expert Opin Drug Saf,2012,11(5):767-778.
[5] 王宁,艾戎,金皎.小儿抗癫痫药高敏综合征1例[J].中华妇幼临床医学杂志,2009,5(4):90-91.
[6] Elzagallaai AA,Garciabournissen F,Finkelstein Y,et al.Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han Chinese child with a positive HLA-B*1502 and negative in vitro toxicity assays:evidence for different pathophysiological mechanisms[J].Popul Ther Clin Pharmacol,2011,18(1):e1-e9.
[7] Dredge DC,Parsons EC,Carter LP,et al.Anticonvulsant hypersensitivity syndrome treated with intravenous immunoglobulin[J].Pediatr Neurol,2010,43(1):65-69.
[8] 侯蕴祈,石海琴,杨红姬.HLA-B*1502表达与AEDs致敏相关性的临床研究[J].中风与神经疾病杂志,2017,34(12):1090-1092.
[9] 黄亚莉,任惠.芳香族抗癫痫药物所致严重皮肤不良反应的研究进展[J].癫痫杂志,2017,3(4):325-328.
[10] Grover S,Kukreti R.HLA alleles and hypersensitivity to carbamazepine:an updated systematic review with meta-analysis[J].Pharmacogenetics & Genomics,2014,24(2):104-112.
[11] Trivedi BS,Darji NH,Malhotra SD,et al.Antiepileptic drugs-induced Stevens-Johnson syndrome:a case series[J].J Basic Clin Pharm,2016,8(1):42-44.
[12] Wang XQ,Lv B,Wang HF,et al.Lamotrigine induced DIHS /DRESS:Manifestations,treatment,and outcome in 57 patients[J].Clinical Neurology and Neurosurgery,2015,138(11):1-7.
[13] 中华医学会.临床诊疗指南-癫痫病分册[M].北京:人民卫生出版社,2007,51-52.
[14] 梅昕,沈继斌,刘立民.抗癫痫药物诱发高敏综合征1例临床分析[J].中国皮肤性病学杂志,2015,29(3):265-266,287.
[15] 余永林,夏哲智.儿童抗癫痫药过敏反应36例[J].中国现代药物应用,2009,3(20):130-132.