肿瘤坏死因子拮抗剂治疗重症三氯乙烯药疹样皮炎  

A tumor necrosis factor antagonist in the treatment of severe medicamentosa-like dermatitis induced by trichloroethylene： a clinical observation

作　　者：丁兰[1] 路丹丹[1] 施辛[1] 孙晓东[1] 闫志华[1] 凌昕[1] 刘润秋[1] 季孙平[1] 黎平[1] 张静[1] 陈小建[1] 陈玲玲[1] 谢立夏[1] 

机构地区：[1]苏州大学附属第二医院皮肤科,215004

出　　处：《中华皮肤科杂志》2014年第4期243-246,共4页Chinese Journal of Dermatology

摘　　要：目的观察肿瘤坏死因子拮抗剂在重症三氯乙烯药疹样皮炎治疗中的作用。方法5例以皮疹、发热、浅表淋巴结肿大和肝、肾损害为主要表现的重症三氯乙烯药疹样皮炎患者，在判断无肿瘤、结核及重症感染后，3例采用肿瘤坏死因子拮抗剂25mg皮下注射，每周2次，联合糖皮质激素治疗；2例单独使用肿瘤坏死因子拮抗剂治疗。结果肿瘤坏死因子拮抗剂联合糖皮质激素治疗的3例患者体温在1周内降至正常，住院期间未发生感染、急性肝功能衰竭等，出院时皮疹消退，口腔、外阴等黏膜恢复正常，肝肾功能正常，平均住院时间36d。单独使用肿瘤坏死因子拮抗剂的2例患者均治愈，临床疗效与联合糖皮质激素治疗的患者无明显差别，治疗后28周测得血清肿瘤坏死因子仪水平降至正常。结论在重症三氯乙烯药疹样皮炎的治疗过程中尽早、足量使用肿瘤坏死因子拮抗剂有益于陕速控制病情。Objective To estimate the effect of a tumor necrosis factor antagonist in the treatment of medicamentosa-like dermatitis induced by trichloroethylene. Methods Five patients, who presented with skin eruptions, fever, superficial lymphadenectasis, hepatic and renal damage, were diagnosed with severe medicamentosa-like dermatitis induced by trichloroethylene. Of them, three patients, who had been confirmed not to have tumor, tuberculosis or severe infection, were treated with a recombinant human tumor necrosis factor antagonist （25 mg, subcutaneous injection, twice per week） combined with glucocorticoid, and the other two patients were treated with the tumor necrosis factor antagonist alone. Results In the three patients treated with the tumor necrosis factor antagonist combined with glucocorticoid, body temperature dropped into the normal range within a week. No infection or acute hepatic failure was observed during their hospitalizations. When they were discharged from hospital, the skin rashes subsided, oral and vulval mucosae were recovered, and hepatic and renal function was restored, with the median hospital stay being 36 days. The other two patients treated with the tumor necrosis factor antagonist alone were also cured, and the serum level of tumor necrosis factor-a returned to normal on week 28 after initiation of treatment. There was no significant difference in clinical efficacy between the combination therapy and monotherapy. Conclusion To use a tumor necrosis factor antagonist at an adequate dose as early as possible is beneficial to the treatment of severe medicamentosa-like dermatitis induced by trichloroethylene.

关 键 词：三氯乙烯 药疹 肿瘤坏死因子拮抗剂 药物疗法 

分 类 号：R758.21[医药卫生—皮肤病学与性病学]