三氯乙烯所致药疹样皮炎50例临床分析

A clinical analysis of 50 cases of medicament-like dermatitis due to trichloroethylene

目的 了解三氯乙烯 (TCE)所致药疹样皮炎的临床特点、并发症 ,探讨治疗方法 ,为研究病因和发病机制提供依据。方法 对 1997～ 2 0 0 0年在我院住院的 5 0例TCE所致药疹样皮炎患者临床资料进行回顾性分析。结果 患者发病与接触浓度不平行 ,无明显的剂量 -效应关系 ,呼吸道或皮肤接触均可发病 ;潜伏期 5～ 6 6d ,平均潜伏期 31.5d(M) ;临床表现以皮肤损害、发热、浅表淋巴结肿大和肝功能损害为主 ;感染为主要并发症 ;糖皮质激素治疗有效。结论 患者临床表现类似药疹 ,临床分型以剥脱性皮炎、多形红斑为主 ;发病机制应属变态反应 ,而IV型可能性大。早期、适量、足程使用糖皮质激素 ,加强皮肤护理 ,积极护肝及防治感染 ,是提高TCE所致药疹样皮炎患者生存率的关键。

Objective To investigate the clinical manifestations,compalications and treatment of medicament-like dermatitis due to trichloroethylene(TCE),so as to provide basis for studying its etiology and mechanism. Methods Fifty patients with dermatitis due to TCE from 1997 to 2000 were analysed retrospectively. Results The occurrence of the dermatitis was not parallel to TCE exposure levels,without significant dose-effect ralationship.This disease could be caused by both inhalation and skin exposure.The latency period of TCE dermatitis ranged from 5 to 66 days,and the average was 31.5 d(Medium).The major clinical manifestations included skin lesions,fever,superficial lymph node swelling and liver dysfunction.Infection was the major compalication.Glucocorticoid was effective for treatment of this disease. Conclusion The clinical manifestations due to TCE exposure were similar to dermatitis medicamentosa.The major clinical types of TCE dermatitis included exfoliative dermatitis and erythema multiforme.The dermatitis is considered to be mediated by delayed-type(IV) hypersensitivity.The key factors to treat this disease successfully included the use of glucocorticoid in time with sufficient dose and full course,professional skin care,active treatment to protect the liver and to avoid infection.