表皮坏死型药疹住院患者50例临床分析

Clinical Analysis of 50 Inpatients with Epidermal Necrotic Drug Eruption

目的探讨表皮坏死型药疹的临床特点,为科学防治提供借鉴。方法对确诊为表皮坏死型药疹的50例患者临床资料进行回顾性分析。结果 50例患者中,致敏药物包括卡马西平、别嘌呤醇和拉莫三嗪、解热镇痛类药物、抗菌药物、某些中药制剂,以及三氯乙烯和醋甲唑胺等;卡马西平、别嘌呤醇、拉莫三嗪、三氯乙烯诱发的表皮坏死型药疹,其潜伏期相对较长;36例既往没有明确的药敏史;32例患者有不同程度发热,13例有浅表淋巴结肿大;入院时20例皮损表现是Stevens-Johnson综合征(SJS),20例是中毒性表皮坏死松解症(TEN),10例入院后由SJS发展为TEN,16例有肝损,10例有肾损,6例出现血液嗜酸性粒细胞(EOS)增多;48例均及早使用大剂量皮质类固醇激素控制病情,36例在入院早期即同时使用了大剂量静脉用免疫球蛋白(IVIG)。50例病情均得到有效控制,但病程反复迁延不一,15例出现严重的二重感染,住院时间4~51d,平均19.78d。结论表皮坏死型药疹虽然危重,但是只要早期确诊、及时停用致敏药物,积极有效救治,包括早期足量大剂量皮质类固醇激素,必要时辅助大剂量IVIG、防治可能的二重感染等措施,本型药疹是可以得到有效控制的。

Objective To investigation the clinical characteristics of epidermal necrotic drug eruption.Methods A retrospective analysis was implemented on the clinical data of 50 inpatients with epidermal necrotic drug eruption in our dermatological wards.Results Among these 50 cases,allergenic drugsinclude carbamazepine,allopurinol,lamotrigine,antipyretic analgesic drugs,antibiotics,certain Chinese traditional medicine preparations,trichlorethylene and methazolamide,etc. Relatively long incubation periods were observed in the cases which were induced by carbamazepine,allopurinol,lamotrigine or trichloroethylene. However,up to 36 cases had no clear history of drug sensitivity before. In clinical feature,as many as 32 patients had varying degrees of fever,and 13 patients had superficial lymphadenectasis. There were 20 cases that manifestedas Stevens-Johnson syndrome（ SJS）,and another20 cases that were toxic epidermal necrolysis（ TEN）,while 10 cases had developed from SJS to TEN. In addition,16 had liver damage,10 had kidney loss,and 6 had eosinophilia. In treatment,48 patients were treated with high-dose corticosteroids as early as possible,and 36 patients used high-dose IVIG at the same time. In terms of outcome,the courses of disease were of different,and hospital stay could take from 4 to 51 days with an average of 19. 78 days. Although there were 15 patients whichsuffered from severe secondary infection,all these 50 cases had already been effectively controlled.Conclusion Though epidermal necrotic drug eruptionis always critical,it can be effectively controlled with the early diagnosis,timely disabling allergenic drugs,active and effective treatment,including early enough high-dose corticosteroids,high-dose IVIG if necessary,and prevention of secondary infection.