喹诺酮类药物致Stevens-Johnson综合征和中毒性表皮坏死松解症文献分析

目的： 分析喹诺酮类药物致Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）不良反应的发生情况，为临床合理用药提供参考。方法： 通过PubMed、Web of Science、Springer、Embase、Scopus、万方期刊论文数据库、维普期刊数据库、中国知网（CNKI）、中国生物医学文献（CBM）等数据库查找2004年1月-2021年3月期间国内外临床上应用喹诺酮类药物导致皮肤系统不良反应的文献，筛选出符合标准的病例进行统计和分析，共收集有效文献25篇（28例）。结果： 喹诺酮类药物致SJS病例11例（39.29%），其中男性5例（45.45%），女性6例（54.55%），60岁以上6例（54.55%）；喹诺酮类药物致TEN病例14例（50%），其中男性9例（64.29%），女性5例（35.71%），60岁以上8例（57.14%）；喹诺酮类药物致SJS/TEN重叠征3例（10.71%），其中男性1例（33.33%），女性2例（66.67%），60岁以上2例（66.67%）。统计文献发现，SJS/TEN致病率最高的喹诺酮类药物为左氧氟沙星，分别为SJS 8例（72.72%）、TEN 8例（57.14%）和SJS/TEN重叠征1例（33.33%）。SJS不良反应发生时间为用药后的3 h~10 d，TEN不良反应发生时间为用药后的4 h~18 d，SJS的死亡率为9.09%，TEN的死亡率为28.57%。结论： 喹诺酮类药物可导致SJS/TEN，早期识别出致病药物可有效改善预后。同时应加强用药监测，以减少不良反应的发生。

Literature analysis of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis induced by quinolones

OBJECTIVE To analyze the incidence of Stevens-Johnson symptom(SJS)and toxic epidermal necrolysis(TEN)adverse reactions induced by quinolones,so as to provide reference for clinical rational use of drug.METHODS Through the databases(PubMed,Web of Science,Springer,Embase,Scopus,WanFang Journal Articles Database,VIP Journal Database,China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBM),etc.),the literatures about the adverse reactions of skin system caused by the clinical application of quinolones at home and abroad from January 2004 to March 2021 were searched and statistically analyzed.RESULTS A total of 25 effective literatures(28 cases)were collected.In 25 articles,there were 11 cases(39.29%)of SJS caused by quinolones,among which 5 cases(45.45%)were male and 6 cases(54.55%)were female.There were 6 cases(54.55%)with higher incidence of adverse reactions over 60 years old;14 cases(50%)of TEN were caused by quinolones,including 9 cases(64.29%)of male and 5 cases(35.71%)of female caused by quinolones.There were 8 cases(57.14%)with higher incidence of adverse reactions over 60 years old;There were 3 case(10.71%)of SJS/TEN caused by quinolones,including 1 cases(33.33%)of male and 2 cases(66.67%)of female.There were 2 cases(66.67%)with higher incidence of adverse reactions over 60 years old.According to the statistics of literature,levofloxacin was the most common quinolones in SJS/TEN,with 8 cases(72.72%)of SJS,8 cases(57.14%)of TEN and 1 case(33.33%)of SJS/TEN.The occurrence time of SJS adverse reaction was 3 h-10 d after treatment,and that of TEN was 4 h-18 d.The mortality of SJS was 9.09%,and that of TEN was 28.57%.CONCLUSION Quinolones can lead to SJS/TEN.It is very important to identify pathogenic drugs for SJS/TEN suspected patients.Early withdrawal can effectively improve the prognosis.