[1]程晓东,张 莹,胡玉皎,等.临床患者检测卡马西平药物基因位点在预防Steven-Johnson综合征和中毒性表皮坏死松解症中的应用[J].现代检验医学杂志,2019,34(04):15-17.[doi:10.3969/j.issn.1671-7414.2019.04.004]
　CHENG Xiao-dong,ZHANG Ying,HU Yu-jiao,et al.Clinical Application of Carbamazepine Drug Gene Locus in the Prevention of Steven-Johnson Syndrome and Toxic Epidermal Necrolysis[J].Journal of Modern Laboratory Medicine,2019,34(04):15-17.[doi:10.3969/j.issn.1671-7414.2019.04.004]
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临床患者检测卡马西平药物基因位点在预防Steven-Johnson综合征和中毒性表皮坏死松解症中的应用()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第34卷
期数:
2019年04期
页码:
15-17
栏目:
论著
出版日期:
2019-08-20

文章信息/Info

Title:
Clinical Application of Carbamazepine Drug Gene Locus in the Prevention of Steven-Johnson Syndrome and Toxic Epidermal Necrolysis
文章编号:
1671-7414(2019)04-015-03
作者:
程晓东; 张 莹; 胡玉皎; 王 昊; 周铁成; 郝晓柯
(空军军医大学第一附属医院全军临床检验中心,西安 710032)
Author(s):
CHENG Xiao-dong; ZHANG Ying; HU Yu-jiao; WANG Hao; ZHOU Tie-cheng; HAO Xiao-ke
(Center of Clinical Laboratory Medicine, the First Affiliated Hospital of Air Force Medical University,Xi'an 710032,China)
关键词:
卡马西平;  Steven-Johnson综合征;  中毒性表皮坏死松解症;  HLA-B*1502TA(C >; G);  HLA-B*1502TB(C>; T)
分类号:
R394.6; R758.2
DOI:
10.3969/j.issn.1671-7414.2019.04.004
文献标志码:
A
摘要:
目的 检测卡马西平药物的耐药位点,为使用卡马西平药物治疗的患者提供精准的用药指导,避免Steven-Johnson综合征和中毒性表皮坏死松解症的出现。方法 收集148例血液样本,使用荧光探针原位杂交技术对卡马西平药物的耐药位点HLA-B*1502TA(C >G)和HLA-B*1502TB(C>T)进行检测和结果分析,评估不同患者卡马西平药物使用的可行性。结果 148例患者中,HLA-B*1502 TA(C >G)位点检测结果为CC(野生型)的患者126例(85.14%),检测结果为CG(杂合突变型)的患者21例(14.19%),检测结果为GG(纯合突变型)的患者1例(0.67%); HLA-B*1502TB(C > T)位点检测结果为CC(野生型)的患者109例(73.65%),检测结果为CT(杂合突变型)的患者37例(25.00%),检测结果为TT(纯合突变型)的患者2例(1.35%)。39.19%(58/148)的患者使用卡马西平有出现Steven-Johnson综合征和中毒性表皮坏死松解症的风险。结论 在使用卡马西平治疗前给患者作卡马西平化学药物基因检测,根据检测结果合理精准用药,可使39.19%患者避免出现Steven-Johnson综合征和中毒性表皮坏死松解症的风险,为患者提供安全用药指导。
Abstract:
Objective To detect the drug resistance site ofcarbamazepine and provide accurate medication guidance for patients treated with carbamazepine to avoid the occurrence of Steven-Johnson syndrome and toxic epidermal necrolysis.Methods A total of 148 blood sampleswere collected and the carbamazepine-resistant sites HLA-B*1502TA(C>G)and HLA-B*1502TB(C>T)were detected and analyzed by fluorescence probe in situ hybridization.To assess the use of carbamazepine in different patients.Results Of the 148 patients,126(85.14%)patients with HLA-B*1502TA(C>G)were found to have CC,and 21 patients(14.19%)with CG,one patient(0.67%)with GG,and 109 patients(73.65%)with HLA-B*1502TB(C>T)site test results for CC,37 patients(25.00%)with CT,and 2 patients(1.35%)with TT.39.19%(58/148)of patients had a risk of developing Steven-Johnson syndrome andtoxic epidermal necrolysis using carbamazepine.Conclusion Before the treatment with carbamazepine,the carbamazepine chemotherapeutic gene test was performed in patients.According to the results of reasonable and accurate drug use,39.19% of patients can avoid the risk of Steven-Johnson syndrome and toxic epidermal necrolysis.Patients provide safe medication guidance.

参考文献/References:

[1] OU G J,WANG J,JI X,et al.A study of HLA-B*15:02 in 9 different Chinese ethnics:Implications for carbamazepine related SJS/TEN[J].HLA,2017,89(4):225-229. [2] HE Xiaojing,JIAN Lingyan,HE Xiaolin,et al.Association between the HLA-B*15:02 allele and carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Han individuals of northeastern China[J].PharmacologicalReports,2013,65(5):1256-1262. [3] HSIAO Y H,HUI RC,WU T,et al.Genotype-phenotype association between HLA and carbamazepine-induced hypersensitivity reactions:strength and clinicalcorrelations[J].Journal of Dermatological Science,2014,73(2):101-109. [4] CHONG K W,CHAN D W,CHEUNG Y B,et al.Association of carbamazepine-induced severe cutaneous drug reactions and HLA-B*1502 allele status,and dose andtreatment duration in paediatric neurology patients in Singapore[J].Archivesof Disease in Childhood,2014,99(6):581-584. [5] KULKANTRAKORN K,TASSANEEYAKUL W,TIAMKAO S,et al.HLA-B*1502 strongly predicts carbamazepine-induced Stevens-Johnson syndrome and toxicepidermal necrolysis in Thai patients with neuropathic pain[J].Pain Pract,2012,12(3):202-208. [6] 高婷婷,龙琴.Stevens-Johnson综合征和中毒性表皮坏死松解症发病机制的研究进展[J].中华眼科杂志,2016,52(9):708-713. GAO Tingting,LONG Qin.Recent progress in research of pathogenesesof Stevens-Johnson syndrome and toxic epidermal necrolysis[J].Chin J Ophthalmol,2016,52(9):708-713. [7] THEN SM,RANI ZZ,RAYMOND AA,et al.Frequency of the HLA-B*1502 allelecontributing to carbamazepine-induced hypersensitivity reactions in a cohort ofMalaysian epilepsy patients[J].Asian Pacific Journal of Allergy and Immunology,2011,29(3):290-293. [8] ELZAGALLAAI AA,GARCIABOURNISSEN F,FI-NKELSTEIN Y,et al.Severe bullous hypersensitivity reactions after exposure to carbamazepine in a Han-Chinese child with a positive HLA-B*1502 and negative in vitro toxicity assays: evidence for different pathophysiological mechanisms[J].J Popul Ther Clin Pharmacol,2011,18(1):e1-9.

备注/Memo

备注/Memo:
作者简介:程晓东(1972-),男,硕士,副主任医师,主要从事临床生化检验,E-mail:xjyyjyk@fmmu.edu.cn。收稿日期:2019-03-21 修回日期:2019-04-08
更新日期/Last Update: 2019-07-30