- 學位論文
台灣嚴重藥物不良反應-史蒂文生氏強生症候群致死案例與藥物交互作用相關性研究
Correlation between Stevens-Johnson Syndrome belonged to Serious Adverse Drug Events and Drug- Drug Interaction in case of death in Taiwan
摘要
目的： 多種藥物的併用，容易導致藥物交互作用的發生，進而衍生許多藥物不良反應。目前罕少有針對SJS發生案例與哪些藥物併用具相關性的研究報告，因此以回溯性研究，探討藥物併用情形與SJS致死案例之相關性，藉以預防SJS案例嚴重致死的發生。 方法： 本研究為縱貫面回溯性研究。擷取1998年至2008年中央健保局申報主診斷為ICD-9-CM 695.1之致死案例為研究對象。使用ANOVA統計方法、獨立樣本T檢定方法(independent-samples T test)檢定、勝算率(OR)及相對危險(RR)分析，探討藥品併用情形與SJS致死之相關性。 結果： 可能與SJS致死有相關之藥物併用組合：Allopurinol併用ampicillin (p=0.049)、Carbamazepine併用sulfamethoxazole/TMP (p＜0.000)、carbamazepine併用phenytoin (p＜0.000)、sulfamethoxazole/TMP併用phenytoin (p=0.015)、Sulfadoxine併用Piroxicam (p=0.045)、Henobarbital併用Cephalexin (p＜0.000)、 Ampicillin併用Erythromycin (p＜0.000)、Erythromycin 併用 Minocycline (p＜0.000)、Vancomycin 併用Ethambutol (p＜0.000)。 結論： 當懷疑SJS發生時，應即刻停止服用所有可疑藥品，並給予症狀支持療法。除了SJS患者應避免再度接觸引發藥物外，所有可能引發SJS藥物之併用亦應提高警覺，以期降低SJS的發生。
並列摘要
Background/Aim: Combination of some drugs would cause interactions between drugs, and this kind of interactions could lead to side effect. So far, there were less related reports about SJS in combination of drugs. Therefore, we study the relationship between drug combination and mortal of SJS that to prevent SIS which lead to death by retrospective study. Methods: This longitude and retrospective study uses mortality cases that diagnoses as ICD-9-CM 695.1 from NHI from 1999 to 2008. Statistical comparisons of the results were made using analysis of variance (ANOVA), independent-samples T test, Odds Ratio (OR), and Relative risk (RR). Therefore, the relationship between combination of SJS drugs and mortality could be found. Results: Possibility relation with drugs combination and mortality : Allopurinol and ampicillin (p=0.049)、Carbamazepine and sulfamethoxazole/TMP (p＜0.000)、carbamazepine and phenytoin (p＜0.000)、sulfamethoxazole/TMP and phenytoin (p=0.015)、Sulfadoxine and Piroxicam (p=0.045)、Henobarbital and Cephalexin (p＜0.000)、Ampicillin and Erythromycin (p＜0.000)、Erythromycin and Minocycline (p＜0.000)、Vancomycin and Ethambutol (p＜0.000)。 Conclusion： Stop to take any possible drugs when SJS occurred and then give supported cure. Exception of SJS patient who should prevented contact with this kind of drugs again; any possible combination of SJS drugs should also be noticed. Key Words：Adverse Drug Reaction、Stevens-Johnson Syndrome、Toxic Epidermal Necrolysis、Drug Interaction、Allergy