半标准剂量免疫球蛋白联合糖皮质激素治疗重症大疱性药疹疗效观察

Effective observation of sub-high dose intravenous immunoglobulin combined with corticosteroid in the treatment of severe bullous drug eruptions

目的：观察半标准剂量免疫球蛋白联合糖皮质激素治疗Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）的疗效。方法：回顾性分析2005年1月~2013年12月于我院皮肤科住院的35例重症大疱性药疹患者,采用SCORTEN评分系统评定疾病严重程度及预后。其中观察组17例,予半标准剂量（0.2g/kg·d）免疫球蛋白联合糖皮质激素治疗。对照组18例,仅予系统性糖皮质激素治疗。观察两组的最大糖皮质激素使用量、起效时间、热退时间、激素减量时间、住院时间,以及继发感染发生率和不良反应。结果：观察组的起效时间、热退时间、激素减量时间、住院时间明显低于对照组（P〈0.05）;但两组之间最大糖皮质激素使用量无明显差异（P〉0.05）;观察组的继发感染和不良反应发生率低于对照组（P〈0.05）。结论：半标准剂量免疫球蛋白联合糖皮质激素治疗较单纯激素治疗起效快,可加快糖皮质激素的减量,缩短住院时间,减少继发感染和不良反应。

Objective：To explore the efficacy for treating toxic epidermal necrolysis and Stevens-Johnson syndrome by half-standard dose intravenous immunoglobulin combining with corticosteroid. Methods：Retrospective analysis of clinical data was made in 35 cases of SJS and TEN from January 2005 to December 2013.The severity and prognosis of these patients can be evaluated by SCORTEN scoring system. 17 patients of the ovservation group were treated by half-standard dose（0.2g/kg·d）intravenous immunoglobulin in combination with corticosteroid.18 patients of the control group were treated with systemic corticosteroids only. The maximum amount of corticosteroid,onset time,fever relief time,corticosteroid reduction time,hospitalization time,the incidence of secondary infection,side effects were observed in two groups. Results：The onset time,fever relief time,corticosteroid reduction time and hospitalization time of the ovservation group were significantly lower than the control group（P0.05）;But there was no significant difference in the maximum amount of corticosteroid between the two groups（P0.05）;The incidence of secondary infection and side effects that in the ovservation group is lower than in the control group. Conclusion：Compared with the therapy by systemic corticosteroids alone,the therapy by halfstandard dose intravenous immunoglobulin combined with corticosteroid is more quickly effective,that can accelerate corticosteroid reduction,shorten the hospitalization time,reduce the incidence of secondary infection and side effects.