| Objective The clinical data of patients with dermatology in our hospital during the past 6 years were collected to analyze the epidemiological characteristics of drug eruptions,risk factors for severe cutaneous adverse reactions(SCARs),abnormal laboratory examination during early drug eruptions,and dialectical classification of local rashes.Methods Using Epidata 3.1 software established database of drug eruption patients,who was screened by the criteria,then use EXCEL and SPSS 22.0 software package analysis of patients' demographic characteristics and drug distribution and rash type,laboratory examination and treatment,etc.Results1.General characteristics of 728 patients Among the 728 patients with drug eruptions,there were 28 minor patients(8.0%),594 young patients(81.6%),88 middle-aged patients(12.1%),and 18 elderly patients(2.5%).There were 287 male patients and 441 female patients with a sex ratio of 1:1.60.The suspected drugs category were ranked according to the frequency of users' proportion : antimicrobial and parasite drugs(57.4%),proprietary Chinese medicines(39.3%),analgesic antipyretic,anti-inflammatory,anti-rheumatic,and anti-gout drugs(18.4%),nervous system medication(9.5%),digestive system medication(6.9%),hormones,and endocrine medication(5.9%),etc.The distribution of rash type according to the proportion of the population was:exanthematous drug eruption(49.0%),urticaria drug eruption(16.3%),erythema multiforme drug eruption(11.4%),acute generalized eruptive pustulosis(6.2%),Stevens-Johnson syndrome(4.5%),drug-induced exfoliative dermatitis(4.1%),fixed drug eruption(3.7%),drug rash with eosinophilia and systemic symptoms(2.1%),eczematous drug eruption(1.1%),purpuric drug eruption(0.8%),toxic epidermal necrolysis(0.4%),photodermatitis drug eruption(0.1%),and vasculitis drug eruption(0.1%).The dialectical classification of TCM local rash classification according to the proportion of the number of people is: hot toxic phlegm type(44.9%),wind-heat type(38.3%),wind-cold outer beam type(5.8%),hot and humid type(5.1 %),rheumatism(4.5%)and wet skin resistance(1.4%).2.Basic features of 187 single-drug patients Among the 187 single-agent patients,there were: 9 minor patients(4.8%),152 young patients(81.3%),22 middle-aged patients(11.8%),and 4 elderly patients(2.1%).There were 78 male patients and 109 female patients with a sex ratio of 1:1.40.The use of sensitized drugs according to the proportion of the frequency of users is: anti-microbial and parasite drugs(49.7%),proprietary Chinese medicines(19.7%),analgesic antipyretic anti-inflammatory and anti-rheumatic and anti-gout drugs(13.3%),nervous system medication(7.0%)and so on.Distribution of rash type according to the proportion of the number of people was:exanthematous drug eruption(46.0%),urticaria drug eruption(16.0%),erythema multiforme drug eruption(11.2%),fixed drug eruption(8.6%),acute generalized eruptive pustulosis(5.9%)and so on.3.Drug and rash distribution in patients with SCARs Major sensitized drugs for SCARs include: anti-microbial and parasitotic drugs,proprietary Chinese medicines,anti-gout drugs,anti-epileptic drugs,and antipyretic analgesics.The main sensitized drugs of AGEP are penicillin drugs,lincomycin drugs and so on;the main sensitizing drugs of SJS are anti-epileptic drugs,anti-gout drugs and so on;the main sensitizing drugs of ED are lincomycin drugs,anti-gout drugs,relieving the heat of Chinese patent medicine and so on;The main sensitizing drug for DRESS is anti-gout drug,and The main sensitizing drug of TEN is antiepileptic drug.4.728 patients with SCARs and N-SCARs Patients with 728 cases of drug eruptions,including: the minor-9 cases of SCARs(32.1% of the minor),19 cases of N-SCARs,youth-92 cases of SCARs(15.5% of the youth),502 cases of N-SCARs,middle-aged patients-19 cases of SCARs(21.6% of the middle-aged patients),69 cases of N-SCARs,elderly patients-6 patients of SCARs(33.3% of the elderly patients),12 cases of N-SCARs.By comparison,the age of patients with SCARs(50 [33,67]years)and those of N-SCARs(49.5 [36.5,62.5]years)were the same(P>0.05).In SCARs,the age of AGEP patients was younger than those in SJS, ED,and DRESS patients(P all less than 0.05).In N-SCARs,the age of urticaria drug eruption patients was younger than those with exanthematous drug eruptions and erythema multiforme drug eruptions(P all less than 0.05).Among the patients with SCARs,64 were males,accounting for 50.8%,and 62 were females,accounting for 49.2%.Among N-SCARs patients,223 were males,accounting for37.0%,379 were females,accounting for 63.0%.Comparisons show that the proportion of men with SCARs is higher than that of N-SCARs men,and the proportion of women with N-SCARs is higher than that of SCARs ones(P<0.05).On the other hand,among all types of drug eruptions,the proportion of men with fixed drug eruption was the highest(74.1%),and that of women with urticaria drug eruption was the highest(76.5%).The comparison showed there was no statistically significant difference in the history of drug allergy and chronic diseases in patients with SCARs and N-SCARs(P all less than0.05).For specific diseases at the same time,in 33 patients with SJS,2 cases with renal insufficiency,1 cases with hepatic insufficiency and 1 cases with brain metastasis tumor,1 case in30 patients with ED with laryngeal cancer surgery and 1 case of merger glioma,1 case of merger of glioma in 15 patients with DRESS.In the early laboratory examination of patients with drug eruptions,the number of patients' porporation with SCARs and N-SCARs who had abnormal TNF-alpha was the highest,both of which were over 90.0%.The comparison shows that the proportion of abnormal WBC#,MONO#,EOS#,PRO,ALT,Ccr,LDH,ESR and CRP in the early laboratory examination of patients with SCARs is higher than that of patients with N-SCARs.(P all less than 0.05).308(42.3%)patients had been systematically treated with glucocorticoids during hospitalization,including 26 patients who received a single dose of glucocorticoid intramuscular injection.The highest dose of hormones in patients with drug eruptions using intravenous or oral steroids was 0.83±0.18 mg/kg/d,among which the highest hormone was 0.80±0.25 mg/kg/d in N-SCARs patients and0.97±0.38mg/kg/d in patients with SCARs.The comparison shows that the maximum hormone dose of SCARs was higher than N-SCARs(P<0.05).On the other hand,the highest dose of hormones in patients with SCARs was higher in patients with SJS(1.19 [0.96,1.42] mg/kg/d)than in AGEP(0.83 [0.67,0.99] mg/kg/d)and ED(0.91 [0.66,1.16]mg/kg/d)(P all less than 0.05).In patients with N-SCARs,the maximum hormone dose in patients with erythema multiforme drug eruption(0.89 [0.70,1.08] mg/kg/d)was higher than that of fixed drug eruption(0.51 [0.29,0.73] mg/kg/d)and urticaria drug eruption(0.67 [0.53,0.84] mg/kg/d)patients(P all less than 0.05).For the hormone reduction time,comparisons showed that: Hormone reduction time of patients with SCARs was longer than N-SCARs patients(P<0.05),and there was no statistical difference in hormone decrement time of patients with SCARs in AGEP,SJS,ED and DRESS.(P all greater than 0.05),patients with erythema multiforme drug eruption in N-SCARs had hormone decrements longer than patients with urticaria eruption and exanthematous drug eruption(P all less than 0.05).A total of 18 patients with SCARs treated with glucocorticoid combined with gamma globulin or other thearpy,including 11 cases of glucocorticoid + gamma globulin infusion(0.4g/Kg/d x 5 days)and 4 cases of glucocorticoid +injection of recombinant human type II tumor necrosis factor receptor-antibody fusion protein(25 mg ih qod x 3-8 times),2 cases of glucocorticoid + cyclosporine(3mg/Kg/d)orally and 1 case of glucocorticoid +gamma globulin(0.4g/Kg/d x 5 days)+ cyclosporine(3 mg/Kg/d).All other patients were discharged from the hospital after routine therapy such as antihistamines,compound glycyrrhizin,and calcium gluconate,and symptomatic treatment.The number of days hospitalized in all patients was 7 [5.5,8.5] days.Comparisons showed that the days of hospitalization for SCARs(9 [5,13] days)were longer than those for N-SCARs(7 [5,9] days)(P< 0.05),and in SCARs,SJS patients in hospital days(14 [10,18] days)were longer than AGEP(7 [4.5,9.5]days)and ED patients(8 [5,11] days)(P all less than 0.05),and in N-SCARs,the number of hospital stays in patients with erythema multiforme drug eruptions(8 [5.5,10.5] days)was longer than those in urticaria eruption(6 [4.5,7.5] days)and exanthematous drug eruption(7 [5,9] days)(P all less than 0.05).Conclusions1.The most common drug eruptions occured to young patients(18-65 years old);female patients with drug eruptions are predominant;microorganism and parasite drug resistance,proprietary Chinese medicine,analgesic antipyretic anti-inflammatory drug resistance rheumatism and gout drug resistance,nervous system,digestive system drugs and hormones,and affect the endocrine drugs,as well as all use a higher frequency of drugs in patients with drug eruption,is also a single drug patients with a higher frequency of sensitization drugs.2.The proportion of SCARs among minor people and elderly people is higher than that of young people and middle-aged people.Males have a higher chance developing SCARs than women.The main sensitizing drugs for SCARs are: anti-microbial and parasite drugs,proprietary Chinese medicines,anti-gout drugs,antiepileptic drugs,and antipyretic analgesics.Overall,the history of drug allergy and combined chronic diseases were not risk factors for SCARs.But for specific disease,in 33 patients with SJS,2 cases with renal insufficiency,1 cases with hepatic insufficiency and1 cases with brain metastasis tumor,1 case in 30 patients with ED with laryngeal cancer surgery and 1 case of merger glioma,1 case of merger of glioma in 15 patients with DRESS.3.The proportions of people with abnormal TNF-? in early laboratory tests in patients with SCARs and N-SCARs were the highest,all over 90.0%,suggesting that it may be an important factor in the pathogenesis of drug eruptions.Comparisons showed that the incidence of abnormalities of WBC#,MONO#,EOS#,PRO,ALT,CCR,LDH,ESR and CRP in early laboratory tests of SCARs was higher than in patients with N-SCARs.4.In the dialectical classification of local skin rashes,the most common symptom was thermal toxicant phlegm,followed by wind-heat occult skin syndrome. |
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