中华皮肤科杂志 ›› 2016, Vol. 49 ›› Issue (7): 465-468.

• 论著 • 上一篇    下一篇

肿瘤坏死因子α拮抗剂治疗Stevens-Johnson综合征17例

经晶1,路丹丹1,施辛1,苏玉华2,季江2,冷红2,吴文雅1,陈晶晶1,谢立夏2,3,丁兰2,徐倩倩1,4,张云1,杨晓雯1,陈小建1,陈玲玲5   

  1. 1. 苏州大学附属第二医院
    2. 苏州大学附属第二医院皮肤科
    3. 成都市第二人民医院
    4. 湖北医药学院附属随州医院皮肤科
    5. 南京医科大学附属苏州医院
  • 收稿日期:2015-10-12 修回日期:2015-11-27 发布日期:2016-06-30
  • 通讯作者: 施辛 E-mail:shx9@163.com

Treatment effect of a tumor necrosis factor-alpha antagonist on 17 patients with Stevens-Johnson syndrome

  • Received:2015-10-12 Revised:2015-11-27 Published:2016-06-30

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摘要：

目的 探讨肿瘤坏死因子拮抗剂在药物引起的Stevens?Johnson综合征治疗中的作用。方法 对17例药物引起的Stevens?Johnson综合征患者，在判断无结核、肝炎、其他重症感染和肿瘤后，采用肿瘤坏死因子α拮抗剂益赛普25 mg（首剂加倍）皮下注射，每3 d 1次，共6次，同时给予支持治疗和复方甘草酸苷注射液抗炎、护肝。结果 17例患者均痊愈。15例发热患者体温在益赛普初次注射24 ~ 48 h内逐渐下降，72 h后恢复正常。所有患者在治疗24 h内停止新发水疱，皮疹色泽由鲜艳转为暗红，72 h后明显控制，2周后基本恢复，4 ~ 5周完全恢复。黏膜部位恢复慢于皮肤损害。14例伴发肝肾损害患者转氨酶在益赛普治疗后逐渐下降，治疗后2 ~ 4周基本恢复正常；尿素氮和肌酐在治疗1 ~ 2周后开始下降。外周血肿瘤坏死因子α水平在治疗后3周内基本下降或维持在正常范围。结论 对于Stevens?Johnson综合征患者尽早、足量使用肿瘤坏死因子拮抗剂有助于快速控制病情。

Abstract:

Jing Jing, Lu Dandan, Shi Xin, Su Yuhua, Ji Jiang, Leng Hong, Wu Wenya, Chen Jingjing, Xie Lixia, Ding Lan, Xu Qianqian, Zhang Yun, Yang Xiaowen, Chen Xiaojian, Chen Lingling Department of Dermatology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China （Jing J, Lu DD, Shi X, Su YH, Ji J, Leng H, Wu WY, Chen JJ, Xie LX, Ding L, Xu QQ, Zhang Y, Yang XW）; Department of Dermatology, Suzhou Municipal Hospital, Suzhou 215006, China （Chen XJ, Chen LL） Corresponding authors: Shi Xin, Email: shx9@163.com; Chen Lingling, Email: chenlingling031@126.com 【Abstract】 Objective To estimate the treatment effect of a tumor necrosis factor?alpha antagonist （etanercept） on Stevens?Johnson syndrome induced by drugs. Methods After exclusion of tuberculosis, hepatitis, severe infections and tumors, 17 patients with drug?induced Stevens?Johnson syndrome were treated with subcutaneous injections of 25 mg （initial dose, 50 mg） etanercept once every 3 days for 6 times. Meanwhile, supportive therapies and compound glycyrrhizin injections were given to counteract inflammation and protect the liver. Results All of the patients were cured. Body temperature in 15 febrile patients gradually decreased within 24 - 48 hours after the first injection of etanercept, and returned to normal in 72 hours. The number of vesicles stopped increasing, and lesion color turned from bright red to dull red within 24 hours. Skin condition was evidently controlled within 72 hours, and skin appearance almost returned to normal after 2 weeks of treatment, and was completely restored after 4 - 5 weeks. The recovery of mucous membrane was slower than that of skin. Serum aminotransferase levels gradually declined after the first dose of etanercept and almost returned to normal in 2 - 4 weeks in 14 patients. Serum levels of urea nitrogen and creatinine began to decrease after 1 - 2 weeks of treatment. The serum level of tumor necrosis factor?alpha nearly dropped into or was maintained in the normal range within 3 weeks after the start of treatment. Conclusion Early usage of tumor necrosis factor?alpha antagonists at an adequate dose is beneficial to the rapid control of Stevens?Johnson syndrome.

引用本文

经晶 路丹丹 施辛 苏玉华 季江 冷红 吴文雅 陈晶晶 谢立夏 丁兰 徐倩倩 张云 杨晓雯 陈小建 陈玲玲. 肿瘤坏死因子α拮抗剂治疗Stevens-Johnson综合征17例[J]. 中华皮肤科杂志, 2016,49(7):465-468. doi: