臺灣博碩士論文加值系統

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。

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

目錄
中文摘要 ………………………………………………………Ⅰ
英文摘要 ………………………………………………………Ⅲ
致謝詞 ………………………………………………………Ⅴ
目錄 ………………………………………………………Ⅵ
表目錄 ………………………………………………………Ⅷ
圖目錄 ………………………………………………………Ⅹ
第一章 研究背景………………………………………………1
第二章 文獻探討………………………………………………3
第一節 名詞解釋………………………………………………3
第二節 病因學 ………………………………………………9
第三節 造成SJS機轉 ………………………………………14
第四節 藥物與SJS相關性……………………………………14
第五節 藥物交互作用與SJS相關性 ………………………20
第三章 研究目的 …………………………………………22
第四章 材料與方法 …………………………………………23
第一節 研究設計 ……………………………………………23
第二節 名詞定義 ……………………………………………25
第三節 病人資訊保障 ………………………………………25
第四節 分析方法 ……………………………………………26
第五章 研究結果 ……………………………………………29
第一節 研究對象特性描述 …………………………………29
第二節 研究對象與易引起SJS藥物併用之關聯性 ………32
第六章 討論 ………………………………………………43
第一節 研究對象與易引起SJS藥物併用之關聯性 ………43
第二節 研究限制 ……………………………………………46
第三節 後續研究 ……………………………………………46
第七章 結論 ………………………………………………46
附錄 …………………………………………………………47
附錄一：易引發SJS藥物交互作用表 …………………………47
附錄二：人體試驗委員會同意臨床試驗證明書 ……………48
參考文獻 ………………………………………………………49

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