Association of major aphthous ulcers and nicorandil
Association of major aphthous ulcers and nicorandil
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DOI：
10.1016/s0140-6736(05)61045-8
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发表时间：
1998-11-14
期刊：
影响因子：
168.9
通讯作者：
Szpirglas, H
中科院分区：
文献类型：
--
作者：
Agbo-Godeau, S;Joly, P;Szpirglas, H
严重的阿弗他溃疡通常是特发性的，但偶尔可能与HIV感染、白塞氏病或中性粒细胞减少症有关。我们报告了16例使用尼可地尔（一种心血管药物）后发生严重阿弗他性口腔溃疡的病例，患者（9例男性，7例女性，中位年龄78岁[范围64-90岁]）接受尼可地尔治疗心绞痛（表）。阿弗他溃疡发作时的中位治疗持续时间为12个月（范围2-36）。12名患者接受40 mg/天，4名患者接受60 mg/天。在2例患者中，当剂量从40 mg/天增加至60 mg/天时发生了口疮性溃疡。3例患者在尼可地尔治疗前偶尔发生轻度阿弗他性口腔炎。病变，1至3个，是典型的疼痛性大阿弗他溃疡，直径超过1厘米，位于舌头，牙龈，或脸颊。无口外体征，实验室检查未显示异常，白色血细胞、血红蛋白和血小板计数、红细胞沉降率以及肾和肝功能均正常。对5名患者进行了组织学评估，显示非特异性溃疡。在三例病例中进行的病毒、细菌和真菌培养均为阴性。前三名患者的艾滋病毒检测结果为阴性。每种主要阿弗他口腔炎的中位持续时间为3个月（范围1-36）。在前6例患者中，最初未诊断出毒性阿弗他溃疡，患者接受沙利度胺25-50 mg/天（n= 3）或秋水仙碱1 mg/天（n= 3）治疗，并继续尼可地尔治疗。所有患者的口疮均在10-15天内完全愈合，但停用秋水仙碱和沙利度胺后立即复发。尼可地尔停药后1-3周，所有16例患者的溃疡完全愈合，无瘢痕。在中位随访12个月（范围1-17）期间，无患者复发。出于伦理原因，我们没有在溃疡愈合后进行尼可地尔再激发试验。
Major aphthous ulcers are generally idiopathic but can occasionally be associated with HIV infection, Behçet's disease, or neutropenia. We report on 16 cases of major aphthous mouth ulcers after use of nicorandil, a cardiovascular drug.The patients (nine men, seven women, median age 78 years [range 64–90]) were treated with nicorandil for angina pectoris (table). The median duration of treatment at the onset of aphthous ulcers was 12 months (range 2–36). 12 patients received 40 mg/day, and four 60 mg/day. In two patients, aphthous ulcers occurred when the dose was increased from 40 mg/day to 60 mg/day. Three patients had occasional minor aphthous stomatitis before treatment by nicorandil. The lesions, one to three in number, were typical painful major aphthous ulcers of more than 1 cm in diameter, and were located on the tongue, gingiva, or cheeks. There were no extraoral signs and laboratory investigations did not show abnormalities, white blood cell, haemoglobin, and platelet counts, erythrocyte sedimentation rates, and kidney and liver functions were normal. Histopathological assessment was done for five patients and showed non-specific ulceration. Viral, bacteriological, and fungal cultures done in three cases were negative. HIV tests done in the first three patients were negative. The median duration of each major aphthous stomatitis was 3 months (range 1–36). In the first six patients, toxic aphthous ulcers were not initially diagnosed and the patients were treated with thalidomide 25–50 mg/day (n= 3) or colchicine 1 mg/day (n= 3) and nicorandil was continued. Aphthous ulcers healed completely in 10–15 days in all these patients, but relapsed immediately when colchicine and thalidomide were stopped. Ulcers healed completely without scars in all 16 patients 1–3 weeks after nicorandil was discontinued. No patient relapsed during a median follow-up of 12 months (range 1–17). For ethical reasons we did not test rechallenge of nicorandil after the ulcers healed.