罕见的药物性小肠结肠炎综合征文献病例分析

Literature case analysis of rare Drug-induced enterocolitis syndrome

关键词:  药物不良反应  药物性小肠结肠炎综合征  病例报道  文献分析

Key words:  Adverse drug reaction  drug induced enterocolitis syndrome  Case reports  Literature analysis

摘要:

目的 研究药物导致的小肠结肠炎综合征(Drug-induced enterocolitis syndrome,DIES)的发生规律和特点,为临床安全用药提供参考。方法 检索建库至2024年12月收录在PubMed、Web of Science、中国知网、万方和维普期刊数据库有关DIES的病例报道,提取文献中的患者信息、药物信息、临床表现、治疗过程等资料并进行整理和分析。结果 共纳入11篇文献共计13例患者,均为欧美人群,男女比例为7:6,其中儿童占比76.92%(10/13)。涉及的药物包括阿莫西林(5例)、阿莫西林克拉维酸(5例)、对乙酰氨基酚(2例)和泮托拉唑(1例)。药物激发试验后发生DIES的潜伏期为1-4小时。DIES临床症状主要表现为持续性呕吐、恶心、腹痛、腹泻、嗜睡等并可能引起脱水、血压下降、心率加快、血氧饱和度下降。患者预后较好,及时给与补液、昂丹司琼、皮质类固醇、抗组胺药等治疗后数小时至几天内症状缓解。结论 DIES是一种罕见的药物导致的迟发性过敏反应。了解它的特点以及临床表现对于评估出现急性胃肠道症状的患者非常重要。临床在使用相关药物的过程中应意识到这种反应的可能性,必要时及时停药或调整治疗方案,以确保用药安全。

Abstract:

To explore the occurrence pattern and characteristics of Drug induced enterocolitis syndrome (DIES) and provide reference for safe clinical medication. METHODS Retrieve databases of PubMed, Embase, CNKI, Wanfang and VIP from the establishment of each database to December 2024. Collect case reports on DIES, extract patient information, medication information, clinical manifestations, treatment processes, and other data from literature, and organize and analyze them. RESULTS A total of 11 articles were included, including 13 patients from European and American populations, with a male to female ratio of 7:6. Among them, children accounted for 76.92% (10/13). The drugs involved include amoxicillin (5 cases), amoxicillin clavulanic acid (5 cases), acetaminophen (2 cases), and pantoprazole (1 case). The incubation period for DIES after drug provocation test is 1-4 hours. The clinical symptoms of DIES mainly include persistent vomiting, nausea, abdominal pain, diarrhea, drowsiness, and may cause dehydration, decreased blood pressure, increased heart rate, and decreased blood oxygen saturation. The patient has a good prognosis, and timely treatment with fluid replacement, ondansetron, corticosteroids, antihistamines, etc. can alleviate symptoms within hours to days. CONCLUSION DIES is a rare delayed allergic reaction caused by medication. Understanding its characteristics and clinical manifestations is crucial for evaluating patients with acute gastrointestinal symptoms. During the clinical use of relevant drugs, the possibility of such reactions should be recognized, and if necessary, medication should be stopped or treatment plans adjusted in a timely manner to ensure medication safety.