亚芪胺类抗癫痫药物引发药物性狼疮的临床特征剖析及风险管理探讨

doi:10.5246/jcps.2026.01.005

中国药学(英文版) ›› 2026, Vol. 35 ›› Issue (1): 71-79.DOI: 10.5246/jcps.2026.01.005

亚芪胺类抗癫痫药物引发药物性狼疮的临床特征剖析及风险管理探讨

常馨予, 范峥, 刘洋, 韩丽娟, 王宏蕾, 李璐瑒, 肖微^*()

首都医科大学附属北京中医医院药学部, 北京 100010

收稿日期:2025-10-09 修回日期:2025-10-30 接受日期:2025-11-07 出版日期:2026-01-31 发布日期:2026-01-31
通讯作者: 肖微

Clinical characteristics and risk management of drug-induced lupus associated with stilbene amine antiepileptic drugs

Xinyu Chang, Zheng Fan, Yang Liu, Lijuan Han, Honglei Wang, Luyang Li, Wei Xiao^*()

Department of Pharmacy, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China

Received:2025-10-09 Revised:2025-10-30 Accepted:2025-11-07 Online:2026-01-31 Published:2026-01-31
Contact: Wei Xiao
Supported by:
Clinical Pharmacy of National TCM Superior Specialties of the National Administration of Traditional Chinese Medicine, Document No. Guozhongyiyaozheng Han [2024] No. 90.

摘要/Abstract

摘要：

本研究旨在探讨亚芪胺类抗癫痫药物卡马西平和奥卡西平诱发药物性狼疮(DIL)不良反应的临床特征及发生规律。研究采用多数据库系统检索策略, 全面收集国内外公开报道的卡马西平、奥卡西平致药物性狼疮不良反应的相关文献并进行系统分析，最终纳入22例符合标准的药物性狼疮个案报告(卡马西平19例, 奥卡西平3例)。数据分析发现发生药物性狼疮不良反应的患者平均年龄为32.50 ± 16.08岁, 且女性占比显著(72.73%, 16/22)。从治疗开始到DIL发作的潜伏期较长且差异较为明显, 平均潜伏期56.93 ± 75.57个月。药物性狼疮不良反应临床表现呈多系统受累特征, 涉及血液系统异常(血小板减少/贫血/白细胞减少, 68.18%)、骨骼系统受累(关节炎/关节疼痛, 59.09%)及皮肤系统(皮疹/光过敏, 54.55%)受累。停药及部分给予激素治疗后, 该不良反应临床症状均有不同程度的改善, 31.82%的患者临床症状在7日内转归。药物性狼疮不良反应具有迟发性及多系统损害的特征, 故建议在抗癫痫药物治疗期间提高警惕性和实施动态监测方案。研究表明在抗癫痫药物治疗中进行动态风险效益评估的必要性,为神经系统药物罕见不良反应风险管理提供了重要的临床依据。

关键词: 抗癫痫药物, 卡马西平, 奥卡西平, 药物性狼疮, 药物不良反应

Abstract:

This study aimed to elucidate the clinical features and temporal patterns of drug-induced lupus (DIL) associated with the stilbene amine antiepileptic drugs carbamazepine and oxcarbazepine. A comprehensive systematic review was conducted using multiple literature databases. Both domestic and international case reports of DIL linked to these agents were screened and analyzed. A total of 22 eligible cases were identified, comprising 19 cases related to carbamazepine and three to oxcarbazepine. Analysis revealed a mean patient age of 32.50 ± 16.08 years, with a marked female predominance (72.73%, 16/22). The latency period, the duration between drug initiation and the onset of DIL, was notably prolonged and variable, averaging 56.93 ± 75.57 months. Clinically, DIL presented as a multi-system disorder, with hematologic abnormalities (e.g., thrombocytopenia, anemia, and leukopenia) observed in 68.18% of cases, musculoskeletal symptoms (arthritis or joint pain) in 59.09%, and cutaneous involvement (rash or photosensitivity) in 54.55%. Following drug discontinuation and, in some instances, glucocorticoid therapy, clinical improvement was observed to varying degrees. Notably, 31.82% of patients experienced complete symptom resolution within 7 d. Given the insidious onset and multi-organ involvement of DIL, our findings underscored the importance of heightened clinical vigilance and routine monitoring protocols during antiepileptic drug therapy. This study highlighted the need for a dynamic risk-benefit assessment in the clinical use of antiepileptic drugs and provides valuable insights for the management of rare but serious neurological adverse reactions.

Key words: Antiepileptic drugs, Carbamazepine, Oxcarbazepine, Drug-induced lupus, Adverse drug reactions

Supporting:

常馨予, 范峥, 刘洋, 韩丽娟, 王宏蕾, 李璐瑒, 肖微. 亚芪胺类抗癫痫药物引发药物性狼疮的临床特征剖析及风险管理探讨[J]. 中国药学(英文版), 2026, 35(1): 71-79.

Xinyu Chang, Zheng Fan, Yang Liu, Lijuan Han, Honglei Wang, Luyang Li, Wei Xiao. Clinical characteristics and risk management of drug-induced lupus associated with stilbene amine antiepileptic drugs[J]. Journal of Chinese Pharmaceutical Sciences, 2026, 35(1): 71-79.

图/表 4

Table 1. Distribution of gender and age in 22 cases.

Table 2. Distribution of the onset time of ADRs.

Table 3. Main manifestations and clinical treatment of ADRs caused by sodium valproate in lupus.

Table 4. ADRs of carbamazepine- and oxcarbazepine-induced lupus mainly involve organs systems and their clinical manifestations.

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亚芪胺类抗癫痫药物引发药物性狼疮的临床特征剖析及风险管理探讨

Clinical characteristics and risk management of drug-induced lupus associated with stilbene amine antiepileptic drugs

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