中毒性表皮坏死松解症和Stevens-Johnson综合征患者营养风险筛查与临床结局的相关性研究

Correlation between nutritional status and clinical outcomes in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome

目的:探讨中毒性表皮坏死松解症(TEN)和Stevens-Johnson综合征(SJS)患者营养风险筛查与临床结局的关系。方法:回顾性分析2011年1月—2021年3月于杭州市第三人民医院住院且临床资料完整的215例TEN和SJS患者。将患者基于营养风险筛查2002量表(NRS2002)进行分组:NRS2002评分≥3分者纳入营养风险组(n=138),NRS2002评分<3分者纳入对照组(n=77)。所有患者均予以常规治疗,比较2组患者不同临床特征之间营养风险的发生率、WBC计数、C反应蛋白(CRP)、TEN疾病严重程度评分(SCORTEN)、皮损愈合时间、住院时间、医院获得性感染发生率和死亡率。结果:TEN和SJS患者营养风险的发生率为64.19%。其中,不同年龄、SCORTEN评分、致敏药物、皮损面积、黏膜受累部位的TEN和SJS患者发生营养风险的差异有统计学意义(P<0.05);而不同性别TEN和SJS患者营养风险发生率比较,差异无统计学意义(P>0.05)。营养风险组患者WBC计数、CRP水平、SCORTEN评分、皮损愈合时间、住院时间、医院获得性感染发生率和死亡率均显著高于对照组(P<0.05)。结论:本研究中存在营养风险的TEN和SJS患者病情重、治疗困难及预后差,提示临床上需引起医生的重视。

Objective:To investigate the relationship between nutritional status and clinical outcomes in patients with toxic epidermal necrolysis(TEN)and Stevens-Johnson syndrome(SJS),and to provide evidence of prognosis of TEN and SJS.Methods:A total of 215 patients with TEN and SJS who were hospitalized in Hangzhou Third People’s Hospital from January 2011 to March 2021 with complete clinical data were collected and studied,retrospectively.Nutritional status was evaluated using nutritional risk screening scores,which were performed based on Nutritional Risk Screening 2002 Scale(NRS2002)score.The patients with NRS2002 scores≥3 were included in the nutritional risk group(n=138).Those with NRS2002 score<3 were included in the control group(n=77).The incidence of nutritional risk,white blood cell count(WBC),C-reactive protein(CRP),severity-of-illness score for TEN(SCORTEN),healing time of skin lesions,length of hospital stay,incidence of hospital-acquired infection and mortality were compared between the two groups.Results:The incidence of nutritional risk in patients with TEN and SJS was 64.19%.The patient’s age,SCORTEN,sensitizing drugs,lesion area,and sites of mucosal involvement were statistically significant for the nutritional risk in the patients with TEN and SJS(P<0.05).There was no significant difference in nutritional risk among patients of different genders(P>0.05).The WBC,CRP,SCORTEN score,healing time of skin lesions,length of hospitalstay,incidence of hospital acquired infection and mortality in the nutritional risk group were significantly higher than those in the control group(P<0.05).Conclusions:Patients with TEN and SJS are more likely to have nutritional risks when they are admitted to the hospital.TEN and SJS patients with nutritional risks are in serious condition,difficult to treat,and have poor prognosis.It is clinically important that these patients receive prompt medical attention and nutritional support.