| Allopurinol is currently used as a first-line drug for the treatment of hyperuricemia(HUA)and gout.It is widely used in clinical practice.However,all patients with severe drug eruption due to allopurinol have a long incubation period,high incidence of sequelae,high mortality and easy liver and kidney damage to the characteristics of its clinical use has been limited.A large number of studies confirmed that HLA-B~*58:01allele and allopurinol-induced severe drug rash there is a strong correlation.Therefore,some gout and HUA guidelines and expert consensus recommendations in the use of allopurinol before the high risk of HLA-B~*58:01 allele detection,if positive is prohibited allopurinol.But strong relevance in different countries,regions and ethnic differences.There are many areas in China still lack of HLA-B~*58:01 allele epidemic of a clear study,Guangxi Nanning area Zhuang and Han population,especially taking or need to take allopurinol gout/HUA population of the allele of the situation is not clear,so this topic will be discussed to understand whether the above-mentioned crowd in the use of allopurinol before the need for HLA-B~*58:01 allele detection.Objective:To understand our hospital in recent years due to drug rash hospitalized patients,due to allopurinol caused by drug eruption,especially in patients with severe drug rash clinical features;The HLA-B~*58:01 gene carrying rate and gene frequency of gout/HUA population aged 40 years old in Zhuang and Han nationality in Nanning,Guangxi;To investigate whether HLA-B~*58:01 gene detection should be routinely detected in the gout/HUA population,especially in the Nanning area,Guangxi,over 40 years old,to reduce or even avoid the occurrence of severe drug eruption.Methods:The study is divided into two parts.In the first part,the clinical data of patients admitted to hospital in recent years were collected and the clinical characteristics of all patients were analyzed and compared with the clinical characteristics of other patients.Part 2:Detection of HLA-B sites in the gout/HUA population of over the 40-year-old Zhuang and Han nationality in Nanning area of Guangxi,taking 260 cases of taking or possibly taking allopurinol using high-resolution PCR-SBT method.Results:The first part of the results:(1)Single drug-induced drug eruption mainly by antipyretic analgesics,penicillin and allopurinol,which mainly by antipyretic analgesics,allopurinol,antiepileptic drugs,Chinese medicine and cephalosporins caused by antibiotics in our hospital;(2)The mean age of allopurinol was 53.62±15.36 years old.The average age of all patients was 46.92±17.40 years old.The age of allopurinol group was higher than that of other single drug group(P<0.05);(3)There were 6 cases of sequelae of allopurinol group and 4cases in other single drug group.The number of sequelae in allopurinol group was higher than that in other single drug group,the difference was statistically significant(P<0.05);(4)The incubation period was 2.00(1.00,5.00)d for all patients in the single-use group and 15.00(5.50,31.50)d for allopurinol group.The latency of allopurinol group was longer than that of other single drug group,the difference was statistically significant(P<0.05);(5)The mean value of ALT in patients with allopurinol was54.96±9.25 U/L,Scr averaged 130.62±88.53 U/L,and ALT in other single drug group was 35.17±5.69 U/L and Scr averaged 80.11±74.14U/L.ALT and Scr in allopurinol group were higher than those in other single drug group,differences were statistically significant(P<0.05).The results of the second part:(1)The proportion of coronary heart disease,stroke,diabetes mellitus,hypertension and dyslipidemia was1.23%,0.25%,26.67%,39.63%and 96.67%respectively in 810asymptomatic HUA patients in Zhuang and Han nationality in Nanning,Guangxi Zhuang Autonomous Region.(2)Among the 130 cases of Han nationality in Guangxi Guangxi Nanning area,23 cases were HLA-B~*58:01 allele carriers,the gene carrying rate and gene frequency were 17.69%and 0.015 respectively.Among the 130 samples of Guangxi Zhuang patients,19 For example,HLA-B~*58:01 allele carriers,gene carrying rate and gene frequency were 14.62%and 0.015;(3)There was no significant difference between the Han nationality group and the Zhuang nationality group(P>0.05),and the Han nationality group and the Zhuang nationality group were compared with the Fujian Han nationality,the Guangzhou Han nationality,the Jiangsu Han nationality,the Shanghai Han,Chinese Han nationality,there was no significant differences(P>0.05).(4)The HLA-B~*58:01 allele carrying rate of allophylline in Guangxi Guangxi Nanning area Zhuang and Han nationality was significantly higher than that in Argentina,Brazil,Cuba,UK,Greece,southern Ireland,northern Italy,Portugal(P<0.05),but there was no significant difference with the Pygmies of Cameroon(Negro population),Indian Delhi and Thai people(P>0.05).The frequency of HLA-B~*58:01 gene in the target population of Guangxi Nanning area Zhuang and Han people over 40years old was lower than that of Indians and Indians in India,and the difference was statistically significant(P<0.05),but with the differences between Argentina,Brazil and Cuba There were no statistically significant differences between the Caucasian race in the UK,Greece,the southern part of Ireland,the northern part of Italy,the Australian,the Caucasian population of the Czech Republic and the Pygmies of Cameroon(Negro),India,Delhi,Germany,Japan(P>0.05);(5)HLA-B~*58:01 allele was detected in 260 cases of Zhuang and Han nationality in Guangxi Nanning area,whether it was for the Zhuang or Han nationality,whether it was HUA or gout,whether taking allopurinol and sex,HLA-B~*58:01 allele carrying rate and gene frequency were not affected(P>0.05).Conclusions:(1)In recent years,our hospital due to drug eruption in patients,the proportion of allopurinol ranked third;and in patients with severe drug eruption,the proportion of allopurinol second,second only to antipyretic analgesic drugs;(2)Compared with other drug eruption,allopurinol caused by drug eruption in patients with age,sequelae incidence,long incubation period,easy to merge liver and kidney dysfunction characteristics;(3)Of the 810 asymptomatic HUA patients enrolled in this study,patients who had a percentage of up to 96.67%may need to undergo uric acid therapy;(4)The HLA-B~*58:01 allele carrying rates were 17.69%and 14.62%in the gout/HUA population of Han and Zhuang in Nanning,Guangxi,respectively.It is suggested that PCR-SBT should be used before the use of allopurinol in this population.If the HLA-B~*58:01 allele was positive,it was advisable not to use allopurinol,can switch to Benzbromarone or Febuxostat and other uric acid drug treatment;(5)Whether it is for the Zhuang or Han nationality,whether the hyperuricemia or gout patients,whether taking allopurinol and gender,these factors on the Nanning area of Guangxi over 40 years of age gout/HUA population HLA-B~*58:01 allele carrying rate And gene frequency were not affected. |
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