关键词: 药疹, 中毒性表皮坏死松解症, 依那西普, 治疗结果, 影响因素分析

Abstract: 【Abstract】 Objective To investigate the factors influencing the efficacy of etanercept in the treatment of toxic epidermal necrolysis （TEN） across different countries and regions. Methods A total of 17 articles (case analyses or case reports) were selected through a comprehensive search in 4 Chinese databases （CNKI, Wanfang, VIP, and SinoMed） and 4 English databases （PubMed, Cochrane Library, Embase, and Elsevier SD）. Clinical data from 52 patients originating from 7 countries were collected. Independent variables included age, sex, race, culprit drugs, disease severity, presence or absence of complications, initial dose, timing of administration, number of administrations of etanercept, and combination therapy; and the duration of hospitalization served as the dependent variable. Univariate and multiple linear regression analyses were conducted sequentially. Results Among the 52 patients, 26 were male and 26 were female, with a median age M （Q1, Q3） of 57.0 （36.0, 71.5） years. The median hospitalization duration was 12.0 （8.0, 17.5） d, and the median severity-of-illness score for TEN （SCORTEN） was 2 （2, 4）. A total of 33 patients （63.5%） had at least one comorbidity. The initial etanercept dose was 50 mg in 37 patients （71.2%）. The median timing of etanercept administration was 3 （3, 6） days after disease onset. Etanercept was used as monotherapy in 26 patients （50.0%） and as combination therapy in 26 patients （50.0%）. Multiple linear regression analysis showed that age （partial regression coefficient β ［95% CI］: -0.106 ［-0.194, -0.018］）, disease severity （2.216 ［0.452, 3.980］）, timing of administration （1.343 ［0.827, 1.858］）, and combination therapy （11.993 ［4.149, 19.838］） significantly influenced the hospitalization duration of TEN patients （all P < 0.05）. However, sex, race, presence of comorbidities, initial dose, and number of administrations did not affect hospitalization duration （all P > 0.05）. Based on the standardized regression coefficients, the factors influencing hospitalization duration in TEN patients were ranked from strongest to weakest as follows: timing of administration （0.632）, combination therapy （0.595）, disease severity （0.337）, and age （-0.233）. Conclusions Early administration of etanercept is the key to achieving clinical benefit in the treatment of TEN. In cases where the response is inadequate or the condition is severe, combination therapy may be considered.

Key words: Drug eruptions, Toxic epidermal necrolysis, Etanercept, Treatment outcome, Root cause analysis