马来西亚柔佛州一家 tertiary 医院的皮肤药物不良反应的流行病学和临床分析。
An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia.
机构信息
Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia.
出版信息
Indian J Dermatol Venereol Leprol. 2012 Nov-Dec;78(6):734-9. doi: 10.4103/0378-6323.102367.
BACKGROUND
The prevalence, clinical patterns, and causative drugs of cutaneous adverse drug reactions (cADR) vary among the different populations previously studied.
AIM
To determine the prevalence, the clinical patterns of drug eruptions, and the common drugs implicated, particularly in severe cADR such as Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophilia and systemic symptoms (DRESS) in our population.
METHODS
We analyzed the database established for all cADR seen by the department of Dermatology from January 2001 till December 2010.
RESULTS
A total of 362 cADR were seen among 42 170 new clinic attendees, yielding an incidence rate of 0.86%. The most common reaction pattern seen was maculopapular eruption (153 cases) followed by SJS/TEN (110 cases) and DRESS (34 cases). Antibiotics was the most commonly implicated drug group (146 cases) followed by anticonvulsants (81 cases) and antigout drugs (50 cases). The most frequently implicated drug was allopurinol (50 cases). Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 21.8%, 20.9%, and 12.7%, respectively, of the 110 cases seen, whereas DRESS was mainly caused by allopurinol (15 cases). Mortality rates for TEN, SJS, and DRESS were 28.6%, 2.2%, and 5.9%, respectively.
CONCLUSIONS
The low rate of cADR with a high proportion of severe reactions observed in this study was probably due to referral bias. Otherwise, the reaction patterns and drugs causing cADR in our population were similar to those seen in other countries. Carbamazepine, allopurinol, and cotrimoxazole were the three main causative drugs of SJS/TEN in our population.
背景
先前研究的不同人群中，皮肤不良反应（cADR）的流行率、临床表现模式和致病药物各不相同。
目的
确定本地区 cADR 的流行率、药物疹的临床表现模式以及常见致病药物，特别是 Stevens-Johnson 综合征/中毒性表皮坏死松解症（SJS/TEN）和药物疹伴嗜酸性粒细胞增多和全身症状（DRESS）等严重 cADR 的情况。
方法
我们分析了皮肤科 2001 年 1 月至 2010 年 12 月期间诊治的所有 cADR 的数据库。
结果
在 42170 名新就诊患者中，共发现 362 例 cADR，发病率为 0.86%。最常见的反应模式是斑丘疹性皮疹（153 例），其次是 SJS/TEN（110 例）和 DRESS（34 例）。抗生素是最常见的致病药物组（146 例），其次是抗惊厥药（81 例）和抗痛风药（50 例）。最常见的致病药物是别嘌醇（50 例）。卡马西平、别嘌醇和复方磺胺甲噁唑是导致 SJS/TEN 的三种主要药物，在 110 例中分别占 21.8%、20.9%和 12.7%，而 DRESS 主要由别嘌醇引起（15 例）。TEN、SJS 和 DRESS 的死亡率分别为 28.6%、2.2%和 5.9%。
结论
本研究中 cADR 的低发生率和高比例的严重反应可能是由于转诊偏倚所致。否则，本地区 cADR 的反应模式和致病药物与其他国家相似。卡马西平、别嘌醇和复方磺胺甲噁唑是本地区 SJS/TEN 的三种主要致病药物。
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