静脉注射丙种球蛋白和糖皮质激素治疗重症大疱性药疹65例  

Intravenous immunoglobulin and corticosteroid in the treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome： a retrospective, comparative study on 65 cases

作　　者：杨永生[1] 徐金华[1] 李锋[1] 朱小华[1] 

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中华皮肤科杂志》2009年第5期330-332,共3页Chinese Journal of Dermatology

摘　　要：目的比较静脉注射丙种球蛋白（IVIG）联合糖皮质激素与糖皮质激素单用治疗重症大疱性药疹的疗效。方法从1993--2007年共收集65例重症大疱性药疹病例，使用中毒性表皮坏死松解症评分（SCORTEN）进行分析。2001年后的病例采用联合治疗，丙种球蛋白剂量0．4g·kg^-1·d^-1连用5d，此前糖皮质激素治疗的病例作为对照。结果在45例糖皮质激素治疗的病例中10例死亡，而预期死亡数8．63。标准死亡比（SMR）分析显示接受糖皮质激素治疗患者的死亡率较常规治疗高16％（SMR=1．16；95％C10．56—2．13）。20例接受联合治疗患者中3例死亡，而预期死亡数3．51（SMR=0．85；95％C10．18—2．50）。在中毒性表皮坏死松解症（TEN）、Stevens—Johnson综合征（SJS）患者中两种疗法死亡率差异均无统计学意义（P〉0．05）。在TEN患者中，联合疗法较之糖皮质激素疗法疾病停止进展时间及总住院时间缩短（t=2．46，3．14，P值均〈0．05），但糖皮质激素减量时间无差异（t=-0．045，P〉0．05）；SJS患者结果相同（z=2．334，t=2．275，t=1．655，P〈0．05，〈0．05，〉0．05）。结论IVIG和糖皮质激素联合治疗较之仅用糖皮质激素治疗显示出死亡率降低的趋势，并能早期控制病情，缩短住院时间；但联合治疗并不能使糖皮质激素早期减量。Objective To compare the efficacy of combination therapy of intravenous immunoglobulin （IVIG） and corticosteroids versus corticosteroids alone in the treatment of toxic epidermal necrolysis （TEN） and Stevens-Johnson syndrome （SJS）. Methods A retrospective study was conducted. Totally, 65 consecutive patients diagnosed as either TEN or SJS from January 1993 to October 2007 were included in this study. For 45 patients collected from 1993 to 2000, including 35 cases of TEN and l0 cases of SJS, methylprednisolone of 1 - 1.5 mg per kilogram bodyweight per day or equivalent hydrocortisone or dexamethasone was given; for the remaining 20 patients collected from 2001 to 2007, including 12 cases of TEN and 8 cases of SJS, additional IVIG （0.4 g·kg^-1·d^-1 for 5 days） was given. The efficacy was evaluated based on SCORTEN, a severity-of-illness-score system for TEN/SJS prognosis. Results Among the 45 patients treated with corticosteroids alone, 8.63 patients were expected to die based on SCORTEN system, while 10 deaths were observed. Standardized mortality ratio （SMR） analysis revealed that the patients treated with corticosteroids alone were 16% more likely to die than those treated with routine therapy （SMR = 1.16; 95% confidence interval, 0.56 - 2.13）. In the remaining 20 patients who received combination therapy, 3 deaths occurred, while 3.51 deaths were expected based on the SCORTEN system. SMR analysis showed that the combination therapy had a trend to reduce the mortality rate of TEN/SJS （SMR = 0.85; 95% confidence interval, 0.18 - 2.50）. No significant difference was noted in the mortality rate of TEN/SJS between the combination therapy and corticosteroid monotherapy （16.7% vs 22.8% in TEN, 12.5% vs 20% in SJS, respectively, both P 〉 0.05 ）. In patients with TEN, the combination therapy significantly reduced the time to arrest disease progression （4.30 ± 2.36 days vs 7.15 ± 3.35 days, t = 2.46, P 〈 0.05） and total hospitalized time （23.40 ± 5.10 days vs 34.30 ±16.00 d

关 键 词：中毒性 表皮坏死松解症 STEVENS-JOHNSON综合征 糖皮质激素 丙种球蛋白类 联合治疗 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]