特发性药物性肝损伤伴和不伴嗜酸性粒细胞增多和全身症状的药物反应。
Idiosyncratic Drug-Induced Liver Injury Associated With and Without Drug Reaction With Eosinophilia and Systemic Symptoms.
机构信息
Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, India.
Department of Dermatology, St. John's Medical College Hospital, Bangalore, India.
出版信息
Am J Gastroenterol. 2022 Oct 1;117(10):1709-1713. doi: 10.14309/ajg.0000000000001913. Epub 2022 Jul 21.
INTRODUCTION
Immunoallergic drug-induced liver injury (DILI) presenting with features of drug reaction with eosinophilia and systemic symptoms (DRESS) is a distinct phenotype. We describe the clinical characteristics, hepatitis pattern, severity, complications, and implicated medications in DILI patients with and without DRESS.
METHODS
Using established criteria, we analyzed DILI registry patients with and without DRESS from 1998 to 2021.
RESULTS
DILI associated with DRESS (DwD) comprised 179 among 943 cases (19%) of DILI. Compared with the cohort without DRESS, patients with DwD are more often women and have shorter latency, lesser degrees of injury ( P < 0.01), and lower mortality (7.8%) than those without DRESS (16%). Antiepileptic drugs (36%), sulfonamides (19%), antituberculosis drugs (14%), antibiotics (10%), and antiretroviral drugs (8%) account for 87% of the cases of DwD.
DISCUSSION
A limited number of drugs cause DwD, representing a fifth of patients with DILI. DwD is characterized by lesser degrees of liver injury and mortality likely because of earlier presentation.
简介
伴有嗜酸性粒细胞增多和全身症状（DRESS）药物反应特征的免疫过敏药物性肝损伤（DILI）是一种独特的表型。我们描述了伴有和不伴有 DRESS 的 DILI 患者的临床特征、肝炎模式、严重程度、并发症和涉及的药物。
方法
使用既定标准，我们分析了 1998 年至 2021 年 DILI 登记患者中伴有和不伴有 DRESS 的情况。
结果
DILI 伴发 DRESS（DwD）在 943 例 DILI 中占 179 例（19%）。与不伴 DRESS 的队列相比，DwD 患者中女性更多，潜伏期更短，损伤程度更低（P<0.01），死亡率更低（7.8%），而非 DRESS 患者（16%）。抗癫痫药（36%）、磺胺类药物（19%）、抗结核药（14%）、抗生素（10%）和抗逆转录病毒药物（8%）占 DwD 病例的 87%。
讨论
少数药物引起 DwD，占 DILI 患者的五分之一。DwD 的特点是肝损伤程度较轻，死亡率较低，可能是因为更早的出现。
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