Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Analysis of Triggers and Implications for Improving Prevention
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Analysis of Triggers and Implications for Improving Prevention
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DOI：
10.1016/j.amjmed.2016.03.022
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发表时间：
2016-11-01
影响因子：
5.9
通讯作者：
Dutz, Jan P.
中科院分区：
文献类型：
--
作者：
Miliszewski, Monica A.;Kirchhof, Mark G.;Dutz, Jan P.
背景技术背景：Stevens-Johnson综合征和中毒性表皮坏死松解症是以广泛表皮脱离为特征的严重皮肤粘膜药物不良反应。据报道，Stevens-Johnson综合征的死亡率在1%至5%之间，中毒性表皮坏死松解症患者的死亡率在25%至35%之间。研究表明，早期识别和及时撤出的病原体，导致增加患者survival.METHODS：一个回顾性的图表审查进行了64例患者入院温哥华总医院诊断史蒂文斯-约翰逊综合征或中毒性表皮坏死松解症，从2001年至2011年。本研究的目的是确定最常涉及触发Stevens-Johnson综合征和中毒性表皮坏死松解症的药物，以及描绘识别和清除这些trigger.RESULTS的时间轴：75%的病例中确定了触发因素。别嘌呤醇是最常见的单一致病因子（20%的病例）。抗惊厥药和抗生素是常见的诱因。致病因子通常在入院/诊断时去除，而不是在症状发作时去除。在19%的已确定触发因素的病例中，注意到既往罪犯药物暴露史和既往皮肤粘膜不良反应。亚洲人和北美原住民的死亡率高于白人，并且亚洲人更常使用别嘌呤醇作为触发因素。Stevens-Johnson综合征/中毒性表皮坏死松解症的发病率和高死亡率可能与不了解Stevens-Johnson综合征和中毒性表皮坏死松解症的早期体征和症状有关，这是导致其的常见药物触发因素，以及可以进行哪些调查（亚洲人的人类白细胞抗原分型）来预防它。（C）2016 Elsevier Inc. All rights reserved.
BACKGROUND: Stevens-Johnson syndrome and toxic epidermal necrolysis are severe mucocutaneous adverse drug reactions characterized by extensive epidermal detachment. The mortality rates have been reported to vary between 1% and 5% for Stevens-Johnson syndrome and 25% and 35% for patients with toxic epidermal necrolysis. Studies have shown that early recognition and prompt withdrawal of the causative agent leads to increased patient survival.METHODS: A retrospective chart review was conducted on 64 patients admitted to Vancouver General Hospital with a diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis from 2001 to 2011. The aim of this study was to identify the medications most often implicated in triggering Stevens-Johnson syndrome and toxic epidermal necrolysis, as well as to delineate the timeline of identification and removal of these triggers.RESULTS: A trigger was identified in 75% of cases. Allopurinol was the single most common offending agent (20% of cases). Anticonvulsants and antibiotics were common triggers. The offending agent was often removed at time of hospital admission/diagnosis but not at onset of symptoms. A history of prior culprit drug exposure with previous mucocutaneous adverse reaction was noted in 19% of cases with identified triggers. Asians and Native North Americans had a higher mortality than whites, and Asians more frequently had allopurinol as a trigger.CONCLUSIONS: The onset and high mortality rate of Stevens-Johnson syndrome/toxic epidermal necrolysis may be related to unawareness of the early signs and symptoms of Stevens-Johnson syndrome and toxic epidermal necrolysis, the common drug triggers that cause it, and what investigations (human leukocyte antigen typing in Asians) can be done to prevent it. (C) 2016 Elsevier Inc. All rights reserved.