Stevens-Johnson综合征/中毒性表皮坏死症的临床分析

Retrospective Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrosis

【目的】探讨Stevens-Johnson综合症(SJS)和中毒性表皮坏死症(TEN)的临床特点。【方法】分析我院2005年6月至2015年5月收治的69例SJS/TEN患者的临床资料。【结果】平均糖皮质激素控制量(1.5±0.4)mg·kg-1·d-1(强的松等效剂量),总死亡率14.5%,其中TEN组SCORTEN评分最高(P<0.001),糖皮质激素控制量和死亡率也显著高于SJS组(P=0.014,0.022)。常见的致敏药物是别嘌醇(19例,27.5%)、抗癫痫药物(17例,24.6%)、NSIAD药物(10例,14.5%)和抗生素(7例,10.1%)。TEN患者最常见的致敏药物是别嘌醇(6例,33.3%),SJS患者是卡马西平(11例,28.2%)。别嘌醇的致敏时间(20.1±6.5)d,卡马西平(12.2±5.4)d,NSAID类药物(2.7±1.9)d,抗生素(3.0±2.2)d。10例死亡患者中,9例因肺部感染导致呼吸功能衰竭死亡。【结论】TEN患者的病情严重程度、激素控制量和死亡率最高。肺部感染是本病主要的死亡原因,别嘌醇和卡马西平是最常见的致敏药物。

[Objective] To study the clinical profiles of Stevens-Johnson syndrome （SJS） and toxic epidermal necrosis （TEN）. [ Methods ] The data of 69 patients with SJS/TEN in our hospital from June 2005 to May 2015 were retrospectively analyzed. [ Results ] Corticostiroid control dose was （1.5 ± 0.4） mg. kg-1. d-1 （prednisone dose） and the total mortality was 14.5%. The SCORTEN of TEN group was the highest （P 〈 0.001 ）. The corticostiroid dose and the mortality of TEN were also significantly higher than that of SJS （P = 0.014, 0.022 respectively）. The major culprit drugs were allopurinol （19, 27.5%）, anticonvulsants （17, 24.6%）, NSIAD （10, 14.5%） and antibiotics （7, 10.1%）. But the major culprit drug was allopurinol in TEN （6, 33.3%） and carbamazepine in SJS （11, 28.2%）. The drug-exposed time was （20.1±6.5）d for allopurinol, （12.2± 5.4）d for carbamazepine, （2.7 ± 1.9）d for NSAID and （3± 2.2）d for antibiotics. In 10 patients died, 9 patients died of respiratory failure due to pulmonary infection. [Conclusion] The severity of disease, the corticostiroid control dose and the mortality in TEN patients are the highest. The main cause of death is pulmonary infection and the major culprit drugs are allopurinol and carbamazepine.