Differences in immunological alterations and underlying viral infections in two well-defined severe drug eruptions
Differences in immunological alterations and underlying viral infections in two well-defined severe drug eruptions
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DOI：
10.1111/j.1365-2230.2010.03820.x
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发表时间：
2010-12-01
影响因子：
4.1
通讯作者：
Shiohara, T.
中科院分区：
文献类型：
--
作者：
Hirahara, K.;Kano, Y.;Shiohara, T.
背景。类似的药物（例如抗惊厥药）与两种不同形式的严重皮肤药物反应的发生有关，即史蒂文斯-约翰逊综合征（SJS）/中毒性表皮坏死松解症（TEN）和药物诱发的过敏综合征（DIHS）/伴有嗜酸性粒细胞增多和全身症状的药疹（DRESS）。研究可能导致这些疾病临床表现变异的免疫学改变和潜在病毒感染。方法。我们使用从 9 名 SJS/TEN 患者和 19 名 DIHS/DRESS 患者发病时获得的样本，回顾性分析了两种药物反应中的临床变量、血清免疫球蛋白水平、循环白细胞、淋巴细胞及其亚群的数量、几种细胞因子的血清水平以及潜在的病毒感染。结果。两次药疹发病前服药时间、发病前IgG、IgA、IgM水平、循环白细胞、淋巴细胞、CD3+T细胞、CD8+T细胞数、血清γ干扰素水平、发病时抗单纯疱疹病毒IgG滴度差异有统计学意义。免疫反应模式的差异部分是由药物暴露时先前和潜在的病毒感染造成的，可能会导致严重药疹的病理表型出现明显偏差。阐明这些宿主因素可能为严重药物反应患者的治疗方法提供基础。
Background. Similar drugs (e. g. anticonvulsants) have been implicated in the development of two distinct forms of severe cutaneous drug reactions, Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS).Aim. To investigate immunological alterations and underlying viral infections that could contribute to the variability in the clinical presentations of these diseases.Methods. We retrospectively analysed clinical variables, serum immunoglobulin levels, numbers of circulating white blood cells, lymphocytes and their subsets, serum levels of several cytokines, and underlying viral infections in both drug reactions, using samples obtained at onset from 9 patients with SJS/TEN and 19 patients with DIHS/DRESS.Results. There were significant differences between the two drug eruptions in the duration of drug intake before onset, the levels of IgG, IgA and IgM, the numbers of circulating white blood cell, lymphocyte, CD3+ T cell and CD8+ T cells, the serum levels of interferon-gamma, and the titres of anti-herpes simplex virus IgG at onset.Conclusions. The difference in the pattern of immune responses shaped in part by previous and underlying viral infections at the time of drug exposure could cause a marked deviation in the pathological phenotype of severe drug eruptions. Elucidating these host factors may provide a basis for therapeutic approaches in patients with severe drug reactions.