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目的探讨药物超敏综合征(DIHS)的临床特点及其诊治方法。方法回顾2013年11月至2015年2月复旦大学附属华山医院皮肤科病房收治的24例药物超敏综合征患者的临床资料。结果 24例病例的可疑致敏药物分别为:别嘌呤醇(16例)、解热镇痛药(2例)、卡马西平(2例)、美西律(2例)、血栓通(1例)和柳氮磺胺吡啶(1例)。患者均以皮疹或发热为首发症状,于用药后3~10周发生,所有患者均出现肝功能异常,此外伴浅表淋巴结大者18例,肾功能损害者18例,白细胞升高者22例,血嗜酸性粒细胞显著升高者18例。结论临床治疗过程中一旦出现发热、全身皮疹伴浅表淋巴结大、血细胞异常以及嗜酸性粒细胞明显增高,且肝或肾功能受损等内脏损害病例要高度怀疑为DIHS,需立即停用可疑致敏药,早期足量使用糖皮质激素联合大剂量丙种球蛋白冲击治疗,有助于降低这一危重疾病的死亡率。
Objective To investigate the clinical features and diagnosis and treatment of drug-hypersensitivity syndrome (DIHS). Methods The clinical data of 24 patients with drug hypersensitivity syndrome admitted to the dermatology department of Huashan Hospital affiliated to Fudan University from November 2013 to February 2015 were retrospectively reviewed. Results The suspicious sensitized drugs in 24 cases were allopurinol (16 cases), antipyretic and analgesic drugs (2 cases), carbamazepine (2 cases), mexiletine (2 cases) and Xueshuantong (1) Case) and sulfasalazine (1 case). Patients with rash or fever as the first symptom occurred in 3 to 10 weeks after treatment, all patients had liver dysfunction, in addition to superficial lymph nodes in 18 cases, 18 cases of renal dysfunction, 22 cases of leukocytosis , Eosinophils significantly increased in 18 cases. Conclusion In the clinical treatment of fever, systemic rash with superficial lymph nodes, abnormal blood cells and eosinophils was significantly increased, and liver or kidney damage and other visceral damage should be highly suspected cases of DIHS, the need to immediately suspend the suspicious Sensitization, early enough use of glucocorticoids combined with high-dose gamma globulin shock therapy, helps to reduce the mortality of this critical illness.