重症多形红斑及中毒性表皮坏死松解症73例临床分析

Clinical analysis of 73 patients with Stevens Johnson syndrome or toxic epidermal necrolysis

目的分析重症多形红斑(SJS)和中毒性表皮坏死松解症(TEN)的致病因素、临床特征及治疗与转归,为其临床防治提供依据。方法回顾性分析杭州市第三人民医院收治的73例SJS和TEN患者的临床资料,其中34例采用注射用甲泼尼龙琥珀酸钠联合静脉用人丙种球蛋白针(A组),39例采用注射用甲泼尼龙琥珀酸钠联合血液透析进行治疗(B组);对其一般资料、致病因素、临床特征、实验室检查结果及治疗与转归进行总结。结果 58例患者有明确病因,其中57例为药物所致,占98.3%;致敏药物以别嘌呤醇和卡马西平为主,分别占34.5%、24.1%。SJS和TEN患者的常见临床特征为体温升高、电解质紊乱、白细胞、肝酶、尿素氮升高,发生率均在30%以上,也有部分伴有血糖升高者,发生率为20.5%;总病原菌检出率91.8%,其中皮肤病原菌检出率最高,占83.6%,菌种主要是金黄色葡萄球菌,占61.6%。A、B两组退热时间、住院时间、死亡率差异无统计学意义(P>0.05),A组费用较低,差异有统计学意义(P<0.05)。结论本地区近2年引起SJS和TEN的常见药物为别嘌呤醇和卡马西平,在对症治疗的基础上,糖皮质激素联合静脉用人丙种球蛋白针或糖皮质激素联合血液透析均能取得较好疗效。

Objective To analyze the pathogenic factors, clinical characteristics, treatment and outcome of Stevens Johnson syndrome （SJS） and toxic epidermal necrolysis （TEN）, so as to provide data for its clinical prevention. Methods The clinical data of 73 patients with SJS or TEN was analyzed, and 34 patients were treated with prednisolone sodium succinate combined immunoglobulin（ Group A） , and 39 patients were treated with prednisolone sodium succinate combined hemato- dialysis （ Group B ）. The general data, pathogenic factors, clinical features, laboratory results, treatment and outcomes were all summarized. Results The etiology of 58 patients has been determined, in which 57 patients were induced by drugs （98.3 % ） ;the drugs were given priority to allopurinol and carbamazepine, accounted for 34.5 % and 24.1% , respective- ly. The common clinical features were fervescence, electrolyte disturbances, elevated leukocyte,liver enzymes and urea ni- trogen,with an occurrence rates over 30% ; the incidence of hyperglycemia was 20.5%. The total pathogenic bacteria positive rate was 91.8%, in which the skin pathogenic bacteria positive rate was the highest （ 83.6% ）. The bacteria were mainly staphylococcus aureus （61.6%）. There was no significant difference in fever subsidence time, hospital stay and death rate between the two groups （ P 〉 0.05 ）. The treatment expense of Group A was lower than that of Group B, the difference had statistical significance（P 〉 0.05 ）. Conclusion In the past two years, the mainly drugs that induced SJS and TEN were purine and carbamazepine. On the basis of symptomatic treatment, both glueocorticoid combined immune globulin and glucocorticoid combined hemodialysis can get good curative effect.