大剂量静脉用丙种球蛋白对重症药疹病情及糖皮质激素使用的影响

Effect of High Dose Intravenous Immunoglobulin on the Condition and Glucocorticoid Use of Severe Drug Eruption

目的探讨大剂量静脉用丙种球蛋白在治疗重症药疹中对糖皮质激素使用及疾病病情缓解的影响。方法收集2012年7月—2017年7月收治49例重症药疹回顾性资料,2017年9月—2019年8月收治16例重症药疹进行前瞻性研究;患者分为激素治疗组和联合治疗组。两组Stevens-Johnson综合征(SJS)和中毒性表皮坏死症(TEN)患者均使用糖皮质激素,使用量为1~2 mg·kg^-1·d^-1(泼尼松)。联合治疗组患者同时给予丙种球蛋白400 mg·kg^-1·d^-1,连续使用3~5 d。分别统计激素治疗组与联合治疗组激素初始剂量、激素减量时间、皮疹好转时间以及住院时间。结果与激素治疗组比较,联合治疗组激素减量时间、皮疹好转时间以及住院时间未缩短,联合治疗组住院费用高于激素治疗组。结论重症药疹SJS和TEM中使用丙种球蛋白未见缩短激素的使用时间以及改善病情的作用。

Objective To investigate the effect of high-dose intravenous immunoglobulin on glucocorticoid use and disease progression in the treatment of severe drug eruptions.Methods We collected retrospective data on 49 cases of severe drug eruptions from July 2012 to July 2017 and prospective data on 16 cases of severe drug eruptions admitted to our department from September 2017 to August 2019,and the patients were divided into glucocorticoid-treated group and combined treatment group.All patients were given 1-2 mg·kg^-1·d^-1 of glucocorticoid,and patients in the combined treatment group were given additional 400 mg·kg^-1·d^-1 of immunoglobulin,which were lasted for 3-5 days.Initial glucocorticoid dose,glucocorticoid reduction time,rash improvement time,and length of hospital stay were statistically analyzed.Results Compared with glucocorticoid-treated group,patients in the combined treatment group did not shorten the glucocorticoid reduction time,the rash improvement time,and the length of hospital stay,and the cost was more than the glucocorticoid-treated group.Conclusion The data in this study suggest that the use of immunoglobulin in Stevens-Johnson syndrome and toxic epidermal necrosis may not shorten the time of glucocorticoid use and the course of the disease.