摘要
目的:分析重症多形红斑(SJS)和中毒性表皮坏死松解症(TEN)致病因素、临床特征、治疗与转归,为临床防治提供理论依据。方法:回顾分析2016年1月~2019年12月弋矶山医院皮肤科收治入院的35例SJS和TEN患者,其中TEN组19例,SJS组16例,对患者致敏药物、年龄、性别、就诊时间、住院天数、发热、受累黏膜部位和白细胞、中性粒细胞(N)百分比、淋巴细胞(L)百分比、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、尿素(BUN)、肌酸激酶同工酶(KMB)、肌酸激酶(CK)、C反应蛋白(CRP)及转归统计分析。结果:致敏药物结果显示TEN组中别嘌醇和中草药各占26.3%,卡马西平、克林霉素和左氧氟沙星分别占10.5%,阿莫西林、甲硝唑和阿奇霉素分别占5.3%。SJS组中致敏药物所占比例分别为别嘌醇43.8%,中草药25.0%,卡马西平和秋水仙碱各占12.5%,阿莫西林6.3%。TEN组来院就诊时间及住院时间均长于SJS组(P<0.05),TEN组发热情况高于SJS组(P<0.05),两组患者治愈率差异无统计学意义(P>0.05)。TEN组WBC、N、AST、ALT、CKMB、CK和CRP指标均高于SJS组(P<0.05),而两组L、Cr和BUN指标差异无统计学意义(P>0.05)。TEN组眼黏膜受累发生率高于SJS组(P<0.05),两组在口黏膜受累、生殖器黏膜受累上差异无统计学意义(P>0.05)。结论:SJS和TEN是属于药疹中最严重类型,需尽快就诊,停用可疑致敏药物,加强皮肤管理,规范使用糖皮质激素和免疫球蛋白。
Objective:To analyze the pathogenic factors,clinical characteristics,treatment and outcomes of Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)for theoretical basis in clinic to prevent and control thedisorder.Methods:Retrospective analysis was performed in 35 patients(SJS,n=16;TEN,n=19)admitted to and treated in our department between January 2016 and December 2019.The clinical data were statistically analyzed regarding sensitization drugs,age,gender,pre-hospital time,days of hospital stay,fever,involved site of invading mucosa,leukocyte count,percentage of neutrophil(N)and lymphocyte(L),levels of alanine aminotransferase(ALT),aspertateaminotransferase(AST),creatinine(Cr),urea(BUN),creatine kinase isoenzyme(CKMB),creatine kinase(CK)and C-reactive protein(CRP)as well as the outcomes.Results:In sensitization drugs,26.3%were associated with allopurinol and Chinese herbal medicine,10.5%with carbamazepine,clindamycin and levofloxacin,and 5.3%with amoxicillin,metronidazole and azithromycin in TEN patients,whereas 43.8%were involved in allopurinol,25.0%in herbal medicine,12.5%in carbamazepine and colchicine,and 6.3%in amoxicillin in patients with SJS.Patients of TEN had delayed pre-hospitaltime,longer days of hospital stay,higher incidence of fever as well as higher level of WBC,N,AST,ALT,CKMB,CK and CRP than those of SJS(all P<0.05),yet the two groups were not statistically different in curative rate,indicators of L,Cr and BUN(P>0.05).The incidence of ocular mucosa involvement was significantly higher in TEN patients than in SJS group(P<0.05),yet there was no difference in oral mucosa involvement and genital mucosa involvement between groups(P>0.05).Conclusion:SJS and TEN are the most serious types of drug eruption,requiring emergency visit.Treatment of the disorders include withdrawal of suspected sensitizing drugs,enhanced skin management,and standardized use of glucocorticoids and immunoglobulin.
作者
强娣
陶运香
唐彪
常小丽
杭守云
慈超
QIANG Di;TAO Yunxiang;TANG Biao;CHANG Xiaoli;HANG Shouyun;CI Chao(Department of Dermatology and STD,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,China)
出处
《皖南医学院学报》
CAS
2020年第2期146-149,共4页
Journal of Wannan Medical College
基金
皖南医学院中青年科研基金项目(WK2018F11)
安徽省高校自然科学研究重大项目(KJ2018ZD027)。
关键词
重症多形红斑
中毒性表皮坏死松解症
致病因素
临床特征
治疗与转归
Stevens-Johnson syndrome
toxic epidermal necrolysis
pathogenic factors
clinical characteristics
treatment and outcome
