Lee S S, Lin H Y, Wang S R, Tsai Y Y
Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1994 Aug;27(3):140-7.
Allopurinol hypersensitivity syndrome (AHS) is an infrequent but life-threatening adverse reaction of allopurinol therapy. The records of 38 patients with the allopurinol hypersensitivity syndrome evaluated at the Veterans General Hospital-Taipei were reviewed. The clinical pictures included fever, rash, leukocytosis, eosinophilia, impaired renal function and hepatocellular injury. Nine patients died (24%) and the major cause of death was infection. The use of corticosteroids increased neither survival nor mortality rate. Twenty-six percent of patients were treated with allopurinol for asymptomatic hyperuricemia, which was not an established indication of the drug, should be avoided. The most important factor of mortality was toxic epidermal necrolysis (TEN) (p < 0.001 compared with other skin lesions). As there is no way to identify the risk group of patients or to make effective treatment for AHS, the only means of minimizing the incidence of AHS is to limit the allopurinol therapy to accepted indications and to adjust the dosage for the patient's renal function.
别嘌醇超敏综合征（AHS）是别嘌醇治疗中一种罕见但危及生命的不良反应。回顾了台北荣民总医院评估的38例别嘌醇超敏综合征患者的病历。临床表现包括发热、皮疹、白细胞增多、嗜酸性粒细胞增多、肾功能损害和肝细胞损伤。9例患者死亡（24%），主要死亡原因是感染。使用糖皮质激素既未提高生存率也未增加死亡率。26%的患者因无症状性高尿酸血症接受别嘌醇治疗，这并非该药物的既定适应证，应避免使用。死亡的最重要因素是中毒性表皮坏死松解症（TEN）（与其他皮肤病变相比，p < 0.001）。由于无法识别患者的风险群体或对AHS进行有效治疗，将AHS发生率降至最低的唯一方法是将别嘌醇治疗限于公认的适应证，并根据患者肾功能调整剂量。
