摘要
目的了解万古霉素致儿童药物超敏反应综合征(DIHS)的临床特点。方法检索国内外数据库(截至2020年5月31日),收集万古霉素致儿童DIHS的病例报告类文献,提取患儿相关信息(性别、年龄、原发病、DIHS发生时间、主要症状、累及器官系统、血液学改变、RegiSCAR评分、治疗及转归等)进行描述性统计分析。结果共收集到万古霉素相关DIHS患儿12例,男性10例,女性2例;年龄22个月~17岁,中位年龄14岁。万古霉素暴露至出现DIHS的时间为5~35 d,中位时间为17 d。12例患儿的主要临床表现为发热(12例,100.0%)、皮疹(12例,100.0%)、淋巴结肿大(8例,66.7%)和黏膜损伤(5例,41.7%);合并肝损伤者9例(75.0%),肾损伤者4例(33.3%),肺损伤者2例(16.7%),脾损伤和心肌损伤者各1例(各8.3%)。11例(91.7%)患儿血常规检查显示嗜酸粒细胞增多,5例(41.7%)非典型淋巴细胞增多。诊断DIHS后12例患儿均停用万古霉素,经治疗(糖皮质激素、抗组胺药、丙种球蛋白等,1例行肝移植)后,11例患儿(91.7%)好转,1例(8.3%)死亡。结论万古霉素致儿童DIHS的临床表现典型,主要表现为发热、皮疹、淋巴结肿大等,受损器官主要是肝脏,其次为肾脏;多数预后较好,少数可出现严重器官功能损伤导致死亡。
Objective To understand the clinical features of vancomycin⁃associated drug⁃induced hypersensitivity syndrome(DIHS)in children.Methods Case reports on vancomycin⁃associated DIHS in children were collected by searching the relevant databases home and abroad up to May 31,2020.Patients′relevant information(sex,age,primary disease,time from medication to onset of DIHS,main symp⁃toms,organs and systems involved,hematological changes,RegiSCAR score,treatment and outcome)was ex⁃tracted and descriptively analyzed.Results A total of 12 children with DIHS caused by vancomycin were enrolled in the study,including 10 males and 2 females.Their ages ranged from 22 months to 17 years,with a median age of 14 years.The median time from vancomycin exposure to occurrence of DIHS was 17 days,ranging from 5 to 35 days.The main clinical features were fever(12 patients,100.0%),rash(12 patients,100.0%),lymphadenopathy(8 patients,66.7%),and mucosal injury(5 patients,41.7%).Among the 12 children,9(75.0%)had liver injury,4(33.3%)had kidney injury,2(16.7%)had lung injury,1(8.3%)had spleen injury,and 1(8.3%)had myocardial injury.Blood routine examination showed increased eosinophilia in the 11 children(91.7%)and increased atypical lymphocytosis in 5 children(41.7%).After the diagnosis of DIHS,vancomycin was discon-tinued in all the 12 children.After treatments with glucocorti⁃coids,antihistamines,gammaglobulins,etc.(1 patient underwent liver transplantation),11 children(91.7%)were improved and 1(8.3%)died.Conclusions The clinical manifestations of DIHS caused by vancomycin in children are typical,mainly manifested by fever,rash,lymphadenopathy,etc.The damaged organs are mainly the liver,followed by the kidneys.Most of the children have a good prognosis,and a few may have severe organ damage leading to death.
作者
李小乐
郭伟
徐勇胜
Li Xiaole;Guo Wei;Xu Yongsheng(Department of Respiratory,Tianjin Children′s Hospital,Tianjin 300134,China)
出处
《药物不良反应杂志》
CSCD
2021年第1期10-14,共5页
Adverse Drug Reactions Journal
