75例重症药疹回顾性分析

Retrospective analysis of 75 cases of severe drug eruption

目的探讨重症药疹的病因、临床特点和治疗方法。方法回顾性分析2005年至2015年75例重症药疹患者的临床资料，根据治疗方法分为标准剂量IVIgG组、半标准剂量IVIgG组以及激素组，采用SCORTEN评分评价病情严重程度及预后。比较三组SCORTEN评分，最大激素使用量、起效时间，激素减量时间和住院时间等指标。结果卡马西平和别嘌呤醇是最常见的致敏药物，以重症多形红斑型最常见。激素组的最大激素使用量大于标准剂量IVIgG组（P＜0.05），激素组的起效时间、激素减量时间、住院时间大于其他两组（P＜0.05）；标准剂量和半标准剂量IVIgG组最大激素使用量、起效时间、激素减量时间、住院时间无统计学差异（P＞0.05）。结论早期联合IVIgG治疗重症药疹是改善预后和降低病死率的有效治疗方法。半标准剂量和标准剂量IVIgG组疗效无显著差异。

Objective To explore the pathogeny, clinical features, and treatment experience of severe drug eruption. Methods Clinical data of 75 patients with severe drug eruption from 2005 to 2015 was retrospectively analyzed. All patients were divided into standard dose IVIgG group, half standard dose IVIgG group, and corticosteroid group according to different regimen. The severity and prognosis of these patients were evaluated by SCORTEN score. SCORTEN score, the maximum amount of corticosteroid, onset time, corticosteroid reduction time, hospitalization time were observed in three groups. Results Carbamazepine and allopurinol were the most common causative drugs. Steven-Johnson syndrome was the most common pattern. The maximum amount of corticosteroid in corticosteroid group was greater than that in standard dose IVIgG group （P〈0.05）. The onset time, corticosteroid reduction time, and hospitalization time of corticosteroid group were significantly greater than those of other two groups （P〈0.05）. There were no statistically significant differences in the maximum amount of corticosteroid, onset time, corticosteroid reduction time, hospitalization time between standard dose IVIgG group and half standard dose IVIgG group （P〉0.05）. Conclusion Early combined IVIgG treatment of severe drug eruption was effective to improve the prognosis and reduce the mortality. There was no significant difference in efficacy between half standard dose IVIgG group and standard dose IVIgG group.