179例抗癫痫药物相关药疹分析

doi:10.19803/j.1672-8629.20250405

摘要/Abstract

摘要： 目的分析抗癫痫药物（AEDs）所致药疹的临床特点,为药品不良反应防治提供参考。方法收集2015年1月1日至2024年12月31日本院收治的179例AEDs相关药疹患者,对致敏药物、潜伏期、临床特征、治疗和转归等进行回顾性分析。结果 179例AEDs相关药疹住院病例中,卡马西平相关药疹占比最高,为86例（48.04%）,中位潜伏期19.00（10.00,25.25）d;其次是拉莫三嗪49例（27.37%）,中位潜伏期14.00（9.25,30.00）d。抗癫痫治疗、治疗神经痛、情感稳定是主要的用药原因。患者中位年龄48（30,64）岁,其中女性105例,男性74例,药疹潜伏期是17.00（10.00,26.00）d。33例患者诊断为重症药疹,包括史蒂文斯-约翰逊综合征26例,中毒性表皮坏死松解症7例。除发疹外,患者常合并C-反应蛋白（CRP）升高（63.69%）、肝功能异常（54.75%）、发热（48.60%）、外周血嗜酸性粒细胞水平升高（23.46%）。停用致敏药物,并使用糖皮质激素（98.32%）、抗组胺药物（60.35%）等是主要治疗措施;对于重症药疹患者,可考虑使用静脉注射人免疫球蛋白（42.42%）。179例患者治疗后好转出院,中位住院日为10.00（8.00,13.00）d。结论多种AEDs均可引发药疹,以发疹型为主,常伴CRP升高、肝功能异常、发热,同时应警惕重症药疹的出现。及时诊治,AEDs相关药疹预后较好。

关键词: 抗癫痫药物, 药疹, 卡马西平, 拉莫三嗪, 丙戊酸, 药品不良反应

Abstract: Objective To analyze the clinical characteristics of drug eruptions caused by antiepileptic drugs (AEDs), and provide a reference for the prevention and treatment of related adverse drug reactions. Methods Retrospective analysis was conducted of the basic data, sensitizing drugs, incubation periods, clinical features, treatments, and outcomes of patients with AEDs-related drug eruptions and admitted to a tertiary hospital in 2015-2024. Results Among the 179 hospitalizations, carbamazepine was the most common causative drug (48.04%), with a median incubation period of 19.00 (10.00, 25.25) days, followed by lamotrigine (27.37%), with a median incubation period of 14.00 (9.25, 30.00) days. The primary approaches to AEDs included epilepsy management, neuropathic pain treatment, and mood stabilization. The median age of the patients (105 females and 74 males) was 48 (30, 64) years. The median incubation period of drug eruptions was 17.00 (10.00, 26.00) days. Thirty-three patients were diagnosed with severe drug eruptions, including 26 cases of Stevens-Johnson syndrome and 7 cases of toxic epidermal necrolysis. In addition to skin manifestations, common findings included elevated CRP levels (63.69%), abnormal liver function (54.75%), fever (48.60%), and elevated peripheral blood eosinophil counts (23.46%). Primary treatments involved discontinuation of the causative drugs and administration of glucocorticoids (98.32%) and antihistamines (60.35%). Intravenous immunoglobulin was administered to some patients with severe drug eruptions (42.42%). All the 179 patients improved and were discharged after treatment, with a median hospital stay of 10.00 (8.00, 13.00) days. Conclusion Multiple AEDs can cause drug eruptions, with maculopapular eruptions being the most common. These eruptions are often accompanied by elevated CRP, abnormal liver function, and fever. Vigilance for the development of severe drug eruptions is crucial. The prognosis is generally favorable with timely diagnosis and appropriate treatment.

Key words: Antiepileptic Drugs, Drug Eruption, Carbama-zepine, Lamotrigine, Valproic Acid, Adverse Drug Reactions

中图分类号:

R971
R994.11

任刘丽, 吕凤文, 夏泉. 179例抗癫痫药物相关药疹分析[J]. 中国药物警戒, 2025, 22(10): 1143-1147.

REN Liuli, LYU Fengwen, XIA Quan. 179 Cases of Drug Eruptions Related to Antiepileptic Drugs[J]. Chinese Journal of Pharmacovigilance, 2025, 22(10): 1143-1147.

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https://zgywjj.magtechjournal.com/CN/Y2025/V22/I10/1143

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