卡马西平致Stevens-Johnson综合征和中毒性表皮坏死松解症24例临床特点及治疗分析

A clinical and treatment analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis induced by carbamazepine in 24 patients

目的探讨卡马西平所致Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)和中毒性表皮坏死松解症(toxic epidermal necrolysis,TEN)的临床特点及治疗转归。方法对无锡市第二人民医院皮肤科2009年—2018年住院治疗的卡马西平所致的24例SJS/TEN重症药疹临床数据进行回顾性分析。结果24例患者中SJS患者20例,TEN患者4例。潜伏期平均(25.0±15.3)d。发热、白细胞数目异常、黏膜损伤、肝功能损伤为常见的临床症状、体征及实验室检查。24例患者均早期足量给予糖皮质激素和(或)人血丙种球蛋白治疗,1例因败血症转入内科治疗,其余23例均好转出院。结论卡马西平所致SJS/TEN重症药疹有潜伏期长、临床症状重、病程长的特点,早期足量给予糖皮质激素和(或)人血丙种球蛋白治疗是临床治愈的关键。

Objective To study the clinical features and the treatment of Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)induced by carbamazepine.Methods Twenty-four patients with SJS/TEN induced by carbamazepine in Dermatology Department of Wuxi No.2 People’s Hospital from 2009 to 2018 were included in the study.Results There were twenty SJS patients and four TEN patients in the 24 cases.The average incubation period was 25.0±15.3 days.Fever,abnormal leukocytes count,mucocutaneous lesions,liver injury were the most common systemic symptoms.All the 24 patients had been given enough systemic steroids and/or intravenous immunoglobulin in the early stage of the disease.One case was transferred to internal medicine department because of hematosepsis,the other 23 cases were cured.Conclusion SJS/TEN induced by carbamazepine is characterized by the longer incubation period,serious symptoms and longer disease duration.Early adequate administration of glucocorticoids and/or human gamma globulin is the key to clinical cure.