Department of Laboratory Medicine, Wuhan Medical and Health Center for Women and Children, Tongji Medical College, Huazhong University of Science and Technology, 100 Xianggang Rd., Jiang An District, Wuhan, Hubei 430016, People's Republic of China.
Eur J Pediatr. 2013 Apr;172(4):537-43. doi: 10.1007/s00431-012-1926-y. Epub 2013 Jan 8.
Although the serum sickness-like reaction (SSLR) in children after the administration of cefaclor has long been recognized, the exact mechanism of cefaclor-associated SSLR remains unclear. This study aims to investigate the association between intestinal mucosal permeability and cefaclor-associated SSLR in children. A total of 82 pediatric patients with upper respiratory tract infection following the cefaclor therapy was divided into cefaclor-associated SSLR positive group and negative group based on the presence or absence of SSLR after taking cefaclor, and 30 healthy volunteers served as control group. Urinary lactulose/mannitol (L/M) ratios and serum diamine oxidase (DAO) levels were determined in all cases on days 7, 9, 11, 13, and 15 after oral administration of cefaclor. The children in the control group were given the same measurements after enrollment in this study. From days 7 to 13, the urinary L/M ratio of children with cefaclor SSLR gradually increased and reached to the highest level of 0.38 ± 0.14 on day 13. Compared with the cefaclor-associated SSLR negative group and control group, urinary L/M ratios increased significantly in the cefaclor SSLR positive group on days 7, 9, 11, 13, and 15 after taking cefaclor, and serum levels of DAO following the treatment of cefaclor increased significantly in children with cefaclor SSLR on days 9, 11, 13, and 15. No significant difference in urinary L/M ratios and serum levels of DAO between SSLR negative group and control group through the entire experiment was observed. In conclusion, administration of cefaclor may induce SSLR in children by increasing the intestinal mucosal permeability and/or affecting the integrity of the intestinal mucosa. Determinations of urinary L/M ratios and serum DAO levels may be helpful for observing or predicting the occurrence of SSLR after administration of cefaclor, which will encourage physicians to proceed with extreme caution when prescribing cefaclor for pediatric patients.
虽然儿童在服用头孢克洛后出现血清病样反应（SSLR）早已得到公认，但头孢克洛相关 SSLR 的确切机制仍不清楚。本研究旨在探讨儿童肠道黏膜通透性与头孢克洛相关 SSLR 的关系。将 82 例上呼吸道感染后接受头孢克洛治疗的儿科患者根据服用头孢克洛后是否出现 SSLR 分为头孢克洛相关 SSLR 阳性组和阴性组，并选择 30 例健康志愿者作为对照组。所有患者在服用头孢克洛后第 7、9、11、13 和 15 天分别测定尿乳果糖/甘露醇（L/M）比值和血清二胺氧化酶（DAO）水平。对照组患者在入组后进行相同的检测。从第 7 天到第 13 天，头孢克洛 SSLR 组患儿尿 L/M 比值逐渐升高，第 13 天达到最高水平 0.38±0.14。与头孢克洛相关 SSLR 阴性组和对照组相比，头孢克洛 SSLR 阳性组患儿在服用头孢克洛后第 7、9、11、13 和 15 天尿 L/M 比值明显升高，且在服用头孢克洛后第 9、11、13 和 15 天血清 DAO 水平明显升高。整个实验过程中，SSL 阴性组与对照组患儿尿 L/M 比值和血清 DAO 水平无明显差异。结论：头孢克洛可能通过增加肠道黏膜通透性和/或影响肠道黏膜完整性引起儿童 SSLR。测定尿 L/M 比值和血清 DAO 水平有助于观察或预测头孢克洛用药后 SSLR 的发生，这将促使医生在为儿科患者开具头孢克洛处方时谨慎行事。
