揭示中毒性表皮坏死松解症的组织学标准及预后意义  

Uncovering histologic criteria with prognostic significance in toxic epidermal necrolysis

作　　者：Quinn A.M Brown K Bonish B.K B.J. Nickoloff 李晓莉 

机构地区：[1]Skin Cancer Research Program, Cardinal Bernardin Cancer Center, Building 112, 2160 S First Ave, Maywood, IL 60153, United States.Dr

出　　处：《世界核心医学期刊文摘（皮肤病学分册）》2005年第10期20-21,共2页Digest of the World Core Medical JOurnals:Dermatology

摘　　要：Objective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30%or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM)-inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN)-were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73%of patients (n=11) with sparse inflammation survived, only 47%(n=7) with moderate and 29%(n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65%using grade of inflammation, 68%with mean cell count, and 71%with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical trObjective: To identify histologic criteria and prognostic significance in patients with toxic epidermal necrolysis (TEN), a frequently lethal disease that usually represents an adverse drug reaction. Design: Retrospective analysis of clinical records and histologic material from a 10-year period (1994-2004). Two investigators blinded to clinical data reviewed hematoxylin-eosin-stained sections. Setting: North American tertiary care, universitybased burn unit. Patients: Thirty-seven patients treated for TEN between 1994 and 2004 who had sloughing of 30%or more of their total body surface area and who underwent skin punch biopsies immediately following admission. Main Outcome Measure: The degree of dermal mononuclear (DM)-inflammation was graded (sparse, moderate, or extensive) at least 2 high-power fields (HPF) away from the perimeter of epidermal detachment, and the mean number of DM cells/5 HPF was quantified for each patient. Clinical records were reviewed and the following data extracted: age, history of cancer, percentage of total body surface area slough, heart rate, and serum glucose, bicarbonate, and serum urea nitrogen values on admission. Severity scores for TEN (SCORTEN)-were calculated, and clinical outcome was recorded as survived or died during hospitalization. Results: Extent of inflammation was assessed by categorizing the mean±SD DM cell counts as follows: sparse, 161±36 cells/HPF (n=15); moderate, 273±76 cells/HPF (n=15); and extensive, 392±124 cells/HPF (n=7). There was good concordance between observer ratings (P<.001). While 73%of patients (n=11) with sparse inflammation survived, only 47%(n=7) with moderate and 29%(n=2) with extensive inflammation survived. The accuracy in predicting patient outcome was 65%using grade of inflammation, 68%with mean cell count, and 71%with SCORTEN. Conclusions: There is a histologic spectrum with TEN that ranges from sparse to extensive DM inflammation, and degree of inflammation predicts clinical outcome approximately as well as SCORTEN. Future clinical tr

关 键 词：预后意义 药物反应 表皮剥脱 细胞计数 三级医疗 炎症程度 临床病历 总体表面积 重度炎症 炎症浸润 

分 类 号：R758.2[医药卫生—皮肤病学与性病学]