中华皮肤科杂志 ›› 2008, Vol. 41 ›› Issue (8): 542-545.

• 论著 • 上一篇    下一篇

Stevens-Johnson综合征及中毒性表皮坏死松解症61例回顾性分析

陈金波 王宝玺 王宏伟 曾跃平 徐浩翔   

  1. 北京协和医院皮肤科 北京协和医院皮肤科 北京协和医院皮肤科 北京协和医院皮肤科 北京协和医院皮肤科
  • 收稿日期:2007-11-01 修回日期:2008-03-16 发布日期:2008-08-15
  • 通讯作者: 陈金波 E-mail:chen999jb@163.com

Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective study of 61 cases

  

  • Received:2007-11-01 Revised:2008-03-16 Published:2008-08-15

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摘要： 目的 探讨Stevens-Johnson综合征（SJS） 及中毒性表皮坏死松解症（TEN）患者的病因及治疗经验。方法 回顾性分析1994年7月至2007年5月确诊为SJS和TEN的61例患者的临床资料，根据治疗分为静脉滴注免疫球蛋白联合糖皮质激素组（简称IVIG组）16例及糖皮质激素组（简称激素组）45例，采用SCORTEN评分评价病情严重程度及预后。比较激素初始量、最大控制量、减量前激素总量、IVIG总量、激素减量前时间、住院时间等指标。结果 引起SJS和TEN常见致敏药物依次为非甾体抗炎药类（26例）、抗癫痫药（15例）、抗生素类（10例），其中最多的为卡马西平（13例）。IVIG组SCORTEN评分（1.44 ± 1.21）显著高于激素组（0.80 ± 1.10），两组差异有统计学意义（P < 0.05）。IVIG组减量前激素总量、减量前时间及住院治疗时间（分别为12.06 ± 4.32 mg/kg，7.81 ± 2.29 d，18.00 ± 5.92 d）与激素组（分别为12.52 ± 8.29 mg/kg，8.29 ± 4.18 d，21.07 ± 13.36 d）比较，差异均无统计学意义。11例SCORTEN评分等于2的患者联用IVIG及激素能使住院治疗时间从（27.57 ± 9.90） d缩短至（14.50 ± 2.38） d（P < 0.05）。IVIG组并发症发生率（43.8％）高于激素组（24.4％）（P < 0.05）。IVIG组与激素组实际死亡率分别为12.5％及4.4％，均低于预期死亡率（分别为12.9％及7.9％）。结论 激素及IVIG治疗SJS和TEN有效。

关键词: Stevens-Johnson综合征, 中毒性表皮坏死松解, 治疗

Abstract: Objective To summarize the etiology and therapeutic regime of Stevens-Johnson syndrome and toxic epidermal necrolysis in 61 hospitalized patients. Methods A retrospective study was performed on 61 patients who were diagnosed with Stevens-Johnson syndrome （SJS） or toxic epidermal necrolysis（TEN） and hospitalized in Peking Union Medical College Hospital through July 1994 to May 2007. Of them, 16 were treated with intravenous immunoglobulins （IVIG） plus corticosteroid （IVIG group） and the other 45 with corticosteroid only （corticosteroid group）. SCORTEN was used to evaluate the severity and prognosis of the disease. The efficacy of therapeutic modalities was assessed by the following parameters: initial dose of corticosteroid, cumulative dose of corticosteroid before the decrease of its dose, controlling dose of corticosteroid, cumulative dose of IVIG, course of corticosteroid application before the decrease of its dose and hospitalization duration. Results The common drugs triggering SJS/TEN in these patients were nonsteroidal anti-inflammation drugs （26 cases）, anticonvulsants （15 cases）, antibiotics （10 cases）, sulfanilamides （3 cases）, other drugs （7 cases）. Of them, carbamazepine was the most sensitizing drug that induced 13 cases of drug eruption. The SCORTEN was significantly higher in IVIG group than in corticosteroid group（1.44 ± 1.21 vs 0.80 ± 1.10, P < 0.05）, whereas no difference was observed in cumulative dose of corticosteroid before the decrease in its dose, course of corticosteroid application before the decrease in its dose and hospitalization duration between the corticosteroid group and IVIG group（12.06 ± 4.32 mg/kg vs 12.52 ± 8.29 mg/kg, 7.81 ± 2.29 d vs 8.29 ± 4.18 d, 18.00 ± 5.92 d vs 21.07 ± 13.36 d, all P > 0.05）. In patients with SCORTEN score of 2, the combination of IVIG and corticosteroid shortened the duration of hospitalization from 27.57 ± 9.90 d to 14.50 ± 2.38 d （P < 0.05）. The incidence of complications was significantly higher in IVIG group than in corticosteroid group （43.8% vs 24.4%, P < 0.05）. The actual mortality was 12.5% and 4.4% in IVIG group and corticosteroid group respectively, which were significantly lower than the predicted value（12.9% and 7.9%, respectively）. Conclusion Corticosteroid and IVIG have beneficial effects on SJS/TEN.

Key words: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Management