Stevens-Johnson综合征和中毒性表皮坏死松解症病死率及相关因素的Meta分析

Meta-Analysis of the Case Fatality Rate and Related Factors of SJS and TEN

目的 系统评价Stevens-Johnson综合征和中毒性表皮坏死松解症(SJS/TEN)患者的病死率特点及其影响因素。方法 计算机检索中国知网、维普、万方数据、PubMed、Web of Science等8个数据库,获取关于SJS/TEN患者病死率等文献,检索时限为近5年(2018—2023)。利用NoteExpress软件进行文献筛选,对纳入的文献进行质量评价并提取资料。采用R 4.2.3软件进行Meta分析。结果 共纳入36篇文献,包括14个国家,20 661例研究对象,其中死亡1 585例。Meta分析结果显示,SJS/TEN患者的病死率为12.59%(95%CI:10.46%~14.73%)。亚组分析结果显示,国内、国外病死率分别为11.97%和12.80%;男、女病死率分别为14.18%和11.51%;SJS、SJS-TEN重叠和TEN的病死率分别为1.18%、9.64%和25.53%,表现出依次递增的趋势;中毒性表皮坏死松解症严重程度评分(SCORTEN评分)为0~1、2、3、4和≥5的病死率分别为1.44%、2.94%、14.95%、45.69%和63.34%,其病死率随分数的增加依次递增;SCORTEN的7个临床变量:年龄、恶性肿瘤、心率等与死亡关系密切。结论 SJS/TEN患者病死率较高,尤其是TEN患者和SCORTEN评分≥5分的患者;病死率的趋势随SCORTEN评分的分值上升而上升,不同型别与病死率有一定关系;SCORTEN的7个临床变量与该病病死率关系密切。

Objective To perform a systematic review of case fatality rate characteristics and influencing factors of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis(SJS/TEN)patients.Methods The eight databases,such as CNKI,VIP,Wanfang Data,PubMed,and Web of Science,were comprehensively and systematically searched in past five years(2018—2023)to obtain studies on case fatality rates of SJS/TEN patients.NoteExpress was used for literature screening,quality evalution of the included literatures and data extraction.R 4.2.3 software was used for Meta-analysis.Results A total of 36 studies were included,including 14 countries and 20661 subjects,among whom 1585 were died.Meta-analysis showed that the case fatality rate of SJS/TEN patients was 12.59%(95%CI:10.46%-14.73%).Subgroup analysis showed that the domestic and foreign case fatality rates were 11.97%and 12.80%,respectively.The case fatality rates of males and females were 14.18%and 11.51%,respectively.The case fatality rates of SJS,SJS-TEN overlap and TEN were 1.18%,9.64%and 25.53%,respectively,showing an increasing trend in sequence.The fatality rates with SCORTEN scores of 0-1,2,3,4,and≥5 were 1.44%,2.94%,14.95%,45.69%and 63.34%,respectively.The fatality rate increased with the increase of the score.The seven clinical variables of SCORTEN,including age,malignancy and heart rate,were closely related to death.Conclusion SJS/TEN patients have a higher case fatality rate,especially those patients with TEN or SCORTEN scores≥5.The trend of case fatality rate increases with the increase of SCORTEN score,and different types have a certain relationship with fatality rate.The seven clinical variables of SCORTEN are closely related to the fatality rate of the disease.