累及眼部的儿童早期重症多形性红斑和Stevens-Johnson综合征临床对比分析

Clinical comparative analysis of early erythema multiforme major and Stevens-Johnson syndrome involving eyes of children

目的比较累及眼部的儿童早期重症多形性红斑(EMM)和Stevens-Johnson综合征(SJS)的临床特点和治疗方法。方法纳入我院眼科2000年1月至2015年12月收治的资料完整的早期EMM患儿25例和早期SJS患儿21例,对其临床诊治资料进行回顾性分析,比较两组患者的临床特点及治疗方案。结果 EMM组患儿年龄(4.7±1.6)岁,明显低于SJS组的(9.1±3.3)岁,差异有显著统计学意义(P<0.01);EMM组患儿发热率为20.0%(5/25)、黏膜受损>2处患儿占比16.0%(4/25)、好转时间(3.6±1.2)d、后遗症发生率0,均明显低于或短于SJS组的85.7%(18/21)、71.4%(15/21)、(11.6±3.9)d、33.3%(7/21),差异均有统计学意义(P<0.05);EMM组患儿的眼部症状仅为结膜充血,SJS组眼部症状更复杂;两组患儿采用多学科综合治疗均能取得较好疗效,但EMM组应用激素治疗后不利于控制疾病,SIS应用激素治疗后预后更好。结论 EMM与SJS在临床表现、治疗转归上均存在一定的差异;对EMM患儿,采用多学科综合治疗且不应用激素治疗,预后较好。

Objective To compare the clinical characteristics and treatment methods of early severe erythema multiforme major(EMM) and Stevens-Johnson syndrome(SJS) involing eyes of children.Methods The clinical data of 25 cases of children with early EMM(EMM group) and 21 cases of children with early SJS(SJS group),who admitted to Department of Ophthalmology of our hospital from January 2000 to December 2015,were analyzed retrospectively,and the clinical characteristics and treatment options of the two groups were compared.Results The average age of EMM group [(4.7±1.6) years] was significantly lower than that of the SJS group [(9.1±3.3) years](P<0.01);The fever rate,children rate with mucosal damage>2,turnaround time,incidence of sequelae in the EMM group [20.0%(5/25),16.0%(4/25),(3.6 ± 1.2) d,0,respectively] were significantly lower or shorter than those in the SJS group [85.7%(18/21),71.4%(15/21),(11.6±3.9) d,33.3%(7/21),respectively](P<0.05);SJS group had more complex eye symptoms than EMM group of children with ocular symptoms only for conjunctival congestion;Using multi-disciplinary comprehensive treatment,the two groups of children could obtain good curative effect.SIS group achieved better prognosis after hormone treatment,but the EMM group was not conducive to control the disease after application of hormone therapy.Conclusion There are some certain differences between EMM and SJS in the clinical manifestation and treatment outcome.Using multi-disciplinary comprehensive treatment and application of hormone therapy,results in better prognosis in EMM children.