中华皮肤科杂志 ›› 2026, e20240544.doi: 10.35541/cjd.20240544

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程序性死亡受体1抑制剂致Stevens-Johnson综合征/中毒性表皮坏死松解症13例临床分析

任孙1    王蓉1    闵玮2   

  1. 1苏州大学附属第一医院皮肤科，苏州  215000；2昆山市第一人民医院皮肤科，苏州  215300
  • 收稿日期:2024-10-12 修回日期:2026-05-26 发布日期:2026-08-10
  • 通讯作者: 闵玮 E-mail:minwei@suda.edu.cn
  • 基金资助:
    苏州市“科教强卫”重点项目（ZDXM2024019）

Clinical analysis of 13 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis induced by programmed cell death 1 inhibitors

Ren Sun¹, Wang Rong¹, Min Wei²   

  1. ¹Department of Dermatology, the First Affiliated Hospital of Soochow University, Suzhou 215000, China; ²Department of Dermatology, the First People's Hospital of Kunshan, Suzhou 215300, China
  • Received:2024-10-12 Revised:2026-05-26 Published:2026-08-10
  • Contact: Min Wei E-mail:minwei@suda.edu.cn
  • Supported by:
    Suzhou Key Project for Strengthening Health through Science and Education（ZDXM2024019）

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摘要： 【摘要】 目的 探讨程序性死亡受体1（PD-1）抑制剂所致Stevens-Johnson综合征（SJS）/中毒性表皮坏死松解症（TEN）的临床特点、治疗措施及疾病转归。方法 本研究为回顾性病例系列研究。收集苏州大学附属第一医院皮肤科2018年1月至2024年9月期间致敏药物为PD-1抑制剂的13例SJS/TEN住院患者的临床资料，使用Naranjo药物不良反应概率量表和表皮坏死松解药物因果关系算法（ALDEN）评估可疑致敏药物，分析患者的临床表现、治疗及转归。结果 13例SJS/TEN患者中，男10例，女3例。6例患者为SJS-TEN，4例为SJS，3例为TEN。发病年龄（x ± s）为（65.23 ± 8.91）岁，范围45 ~ 78岁；病程7 ~ 120 d，中位病程为14 d。所有患者均患有实体恶性肿瘤。经Naranjo评分和ALDEN评分评估，最可能的致敏药物为信迪利单抗、替雷利珠单抗、斯鲁利单抗、特瑞普利单抗、帕博利珠单抗和卡瑞利珠单抗。SJS/TEN发病潜伏期14 ~ 300 d，中位潜伏期为36 d。表皮松解面积为26.08% ± 22.11%，10例出现黏膜受累，4例出现前驱皮疹，3例发生菌血症。所有患者均接受系统糖皮质激素或联合静脉注射免疫球蛋白和/或依那西普治疗，同时给予支持治疗并加强皮肤护理，疗程（21.23 ± 10.19） d。治疗后10例病情好转，3例死亡。结论 PD-1抑制剂引发的SJS/TEN潜伏期较长，病情严重，死亡率高。停用致敏药物，早期使用大剂量糖皮质激素或联合静脉注射免疫球蛋白和/或依那西普治疗能够改善病情。

关键词: 药疹, Stevens-Johnson综合征, 中毒性表皮坏死松解症, 程序性死亡受体1抑制剂, 临床特征

Abstract: 【Abstract】 Objective To investigate the clinical characteristics, treatment strategies, and outcomes of Stevens-Johnson syndrome （SJS） and toxic epidermal necrolysis （TEN） induced by programmed cell death 1 （PD-1） inhibitors. Methods This study was a retrospective case series. Clinical data were collected from 13 hospitalized patients with PD-1 inhibitor-induced SJS/TEN admitted to the Department of Dermatology, the First Affiliated Hospital of Soochow University between January 2018 and September 2024. The Naranjo Adverse Drug Reaction Probability Scale and the Algorithm of Drug Causality for Epidermal Necrolysis （ALDEN） were employed to assess suspected causative agents. Clinical manifestations, treatment regimens, and outcomes were analyzed. Results Of the 13 patients with SJS/TEN, 10 were males and 3 were females. There were 6 patients with SJS-TEN overlap, 4 with SJS, and 3 with TEN. The age at onset was 65.23 ± 8.91 years （range, 45 - 78 years）. The median disease duration was 14 days （range, 7 - 120 days）. All patients had solid malignant tumors. Based on Naranjo and ALDEN scores, the most probable causative drugs were sintilimab, tislelizumab, serplulimab, toripalimab, pembrolizumab, and camrelizumab. The median latency period from PD-1 inhibitor initiation to the onset of SJS/TEN was 36 days （range, 14 - 300 days）. The epidermolysis area was 26.08% ± 22.11%. Mucosal involvement occurred in 10 patients, prodromal rashes in 4, and bacteremia in 3. All the patients were treated with systemic glucocorticoids alone or in combination with intravenous immunoglobulin （IVIg） and/or etanercept, alongside supportive care and intensive skin care. The treatment duration was 21.23 ± 10.19 days. Following treatment, 10 patients showed clinical improvement and 3 died. Conclusions PD-1 inhibitor-induced SJS/TEN was characterized by a prolonged latency, severe clinical manifestations, and high mortality. Discontinuation of the offending agents and early initiation of high-dose systemic glucocorticoids, either alone or in combination with IVIg and/or etanercept, may improve clinical outcomes.

Key words: Drug eruptions, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Programmed cell death 1 inhibitor, Clinical characteristics

引用本文

任孙 王蓉 闵玮. 程序性死亡受体1抑制剂致Stevens-Johnson综合征/中毒性表皮坏死松解症13例临床分析[J]. 中华皮肤科杂志, 2026,e20240544. doi:10.35541/cjd.20240544

Ren Sun¹, Wang Rong¹, Min Wei². Clinical analysis of 13 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis induced by programmed cell death 1 inhibitors[J]. Chinese Journal of Dermatology,2026,e20240544. doi:10.35541/cjd.20240544