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药物反应伴嗜酸性粒细胞增多和全身性症状(DRESS)综合征。

DRESS syndrome.

机构信息

Service de dermatologie, centre hospitalier Bichat Claude-Bernard, 46, rue Henri- Huchard, 75877 Paris, France.

Laboratoire de virologie, hôpital Dupuytren, Limoges, France.

出版信息

Joint Bone Spine. 2014 Jan;81(1):15-21. doi: 10.1016/j.jbspin.2013.05.002. Epub 2013 Jun 29.

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, initially recognized as a serious form of cutaneous drug adverse reaction, is now viewed as a drug-related syndrome that can cause life-threatening organ dysfunctions. Characteristic features include a long time interval from first drug exposure to symptom onset and a prolonged course, often with flares, even after discontinuation of the causal drug. The pathophysiology of DRESS syndrome remains incompletely understood but involves reactivation of herpes viruses (HHV-6, HHV-7, EBV, and CMV), against which the body mounts a strong immune response. The culprit drugs may not only affect epigenetic control mechanisms, thereby promoting viral reactivation, but also induce an antiviral T-cell response by interacting with the major histocompatibility complex receptor in individuals with genetic susceptibility factors. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a potentially life-threatening form of cutaneous drug adverse reaction. The severity of this syndrome is related to the systemic manifestations, which can result in multiorgan failure. DRESS syndrome is characterized by highly specific features, most notably regarding the timing of the manifestations. New insights into the underlying pathophysiological mechanisms indicate a role for immunogenetic susceptibility factors and for reactivation of human herpes viruses (HHVs), chiefly HHV-6. We report a typical case of DRESS syndrome and discuss recent data about this condition.

摘要

药物反应伴嗜酸性粒细胞增多和全身性症状(DRESS)综合征,最初被认为是一种严重的药物皮肤不良反应形式,现在被视为一种与药物相关的综合征,可导致危及生命的器官功能障碍。其特征包括从首次接触药物到出现症状的时间间隔较长,且病程较长,常伴有病情加重,甚至在停用致病药物后仍如此。DRESS 综合征的病理生理学仍不完全清楚,但涉及疱疹病毒(HHV-6、HHV-7、EBV 和 CMV)的再激活,机体对此会产生强烈的免疫反应。致病药物不仅可能影响表观遗传控制机制,从而促进病毒再激活,而且还可能通过与遗传易感因素个体中的主要组织相容性复合体受体相互作用,诱导抗病毒 T 细胞反应。药物反应伴嗜酸性粒细胞增多和全身性症状(DRESS)综合征是一种潜在的危及生命的药物皮肤不良反应形式。该综合征的严重程度与全身表现有关,可能导致多器官衰竭。DRESS 综合征的特征是具有高度特异性,最显著的是关于表现的时间。对潜在病理生理机制的新认识表明,免疫遗传易感因素和人类疱疹病毒(HHV)的再激活起作用,主要是 HHV-6。我们报告了一例典型的 DRESS 综合征病例,并讨论了关于这种疾病的最新数据。

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