Stevens-Johnson综合征和中毒性表皮坏死松解症的疾病进展和治疗转归分析

Disease Progression and Treatment Outcome of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

目的探究Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)的疾病转归和相关影响因素。方法本研究纳入7年间住院治疗的20例诊断为SJS/TEN的患者,记录患者住院期间指标的变化,分析疾病转归和死亡发生的相关影响因素。结果所有患者住院期间,有11例(55.00%)患者疾病在1周内显著改善,有3例患者出现死亡,死亡率为15.00%。受累全身表面积(total body surface area affected,TBSA)和Scorten评分在住院期间总体呈现显著下降趋势(P<0.001),新生上皮面积呈总体上升趋势(P<0.001)。但在入院后的3~7 d时,TBSA和Scorten评分会略微升高,7~14 d时迅速下降。其余指标,如患者的电解质异常比例(P=0.013)、新发皮疹(P=0.006)、新发渗出(P<0.001)以及疼痛评分(P<0.001)等都有显著降低,且差异有统计学意义。结论SJS/TEN在病程中存在先加重后好转的现象,细致的护理工作和物理治疗对于患者疾病的好转至关重要。

Objective To investigate disease outcome and associated influencing factors in Stevens-Johnson syndrome(SJS)and toxic epidermolysis necrolysis(TEN).Methods A total of 20 patients diagnosed with SJS/TEN who were hospitalized in the past 7 years were enrolled in this study.The changes of clinical indicators during hospitalization were recorded to analyze the factors influencing disease coutcome and the occurrence of death.Results Among all patients enrolled,significant disease improvement within 1 week occurred in 11(55.00%)patients and 3 patients died.The mortality rate was 15.00%.There was an overall significant downward trend of total body surface area affected(TBSA)and Scorten score during hospitalization(P<0.001)and an overall increasing trend of new epithelial area(P<0.001).However,TBSA and Scorten scores were slightly elevated at 3 to 7 days after admission and rapidly decreased at 7 to 14 days.Other indicators,such as the proportion of patients with electrolyte abnormality(P=0.013),new rash(P=0.006),new exudate(P<0.001),and pain scores(P<0.001),were also significantly decreased.Conclusion SJS/TEN has an disease exacerbation followed by an improvement in disease development.Meticulous nursing care and physical therapy in addition to medications are essential for the improvement of the patient′s disease.