中毒性表皮坏死松解症的临床特点及预后影响因素分析  

Analysis of the clinical features and prognostic influencing factors of toxic epidermal necrolysis

作　　者：胡正祥 卞徽宁[2] 马丹 罗红敏[2] 孙传伟[2] 赖文[2] Hu Zhengxiang;Bian Huining;Ma Dan;Luo Hongmin;Sun Chuanwei;Lai Wen(Surgery Ward 2,Zhuhai Golden Bay Center Hospital,Zhuhai 519040,China;Department of Burns and Wound Repair,Guangdong Provincial People's Hospital,Guangzhou 510080,China;Zhuhai Center for Disease Control and Prevention,Zhuhai 519000,China)

机构地区：[1]珠海市金湾中心医院外二科,519040 [2]广东省人民医院烧伤与创面修复外科,广州510080 [3]珠海市疾病预防控制中心,519000

出　　处：《中华烧伤杂志》2021年第8期738-746,共9页Chinese Journal of Burns

基　　金：广东省医学科研基金(B2017065)。

摘　　要：目的探讨中毒性表皮坏死松解症(TEN)的临床特点及预后影响因素。方法采用回顾性观察性研究方法。2008年1月—2019年3月,广东省人民医院收治符合入选标准的TEN患者46例,统计患者性别、年龄、入院诊断情况,并发脓毒症患者入住科室类别、有和无重症监护病房(ICU)/烧伤与创面修复外科治疗史脓毒症患者病死比例,患者死亡原因。根据是否并发脓毒症,将患者分为脓毒症组(32例)与非脓毒症组(14例);根据是否死亡,将患者分为死亡组(9例)与存活组(37例)。统计脓毒症组与非脓毒症组患者可疑致病原、合并基础疾病的具体情况,入院时血液中转氨酶/胆红素、肌酐与血小板计数异常情况,病程中病原微生物检测及耐药情况。分别比较脓毒症组和非脓毒症组患者、死亡组和存活组患者入院时性别、年龄、病损面积、TEN严重程度评分(SCORTEN)系统评分、合并基础疾病情况以及病程中血微生物培养阳性情况、激素使用情况、丙种球蛋白使用情况。对数据进行χ^(2)检验、Fisher确切概率法检验、Mann-Whitney U检验。分别选取脓毒症组和非脓毒症组、死亡组和存活组比较中差异有统计学意义的因素进行二分类多因素logistic回归分析,筛选影响TEN患者并发脓毒症、死亡的独立危险因素。结果46例TEN患者中男30例、女16例,年龄8个月~92.0岁,入院诊断为大疱性表皮松解症11例(23.91%)、剥脱性皮炎9例(19.57%)、TEN 9例(19.57%)、大疱性表皮松解型药疹7例(15.22%)、史蒂文斯-约翰逊综合征6例(13.04%)、重症药疹4例(8.70%);并发脓毒症患者入住科室达11个,其中有ICU/烧伤与创面修复外科治疗史患者病死比例与无此类科室治疗史患者相近(P>0.05);死亡患者均并发脓毒症,且主要死亡原因为脓毒症。入院时,脓毒症组患者可疑致病原主要为别嘌醇(8例)与非甾体类消炎药(4例),非脓毒症组患者可疑致病原主要Objective To investigate the clinical features and prognostic influencing factors of toxic epidermal necrolysis(TEN).Methods A retrospective observational study was conducted.From January 2008 to March 2019,a total of 46 TEN patients who met the inclusion criteria were admitted to Guangdong Provincial People's Hospital.The gender,age,and hospital admission diagnosis of the 46 patients,the category of department admitted of patients complicated with sepsis,death ratio of the sepsis patients with or without treatment history in intensive care unit(ICU)/department of burns and wound repair,and the cause of death of the deceased patients were recorded.Depending on whether complicated with sepsis,the patients were divided into sepsis group(32 cases)and non-sepsis group(14 cases).According to whether died or not,the patients were divided into death group(9 cases)and survival group(37 cases).The specific conditions of suspected pathogenic agents and combined underlying diseases,the abnormality of transaminase/bilirubin,creatinine,and platelet count in blood on admission,and the detection of pathogenic microorganisms and drug resistance during the course of disease of patients were recorded in both sepsis group and non-sepsis group.The gender,age,lesion area,severity of illness score for TEN(SCORTEN)system score,combined underlying diseases on admission,and blood microbial culture positivity,hormone use,and gamma globulin use during the course of disease of patients between sepsis group and non-sepsis group,death group and survival group were compared respectively.Data were statistically analyzed with chi-square test,Fisher's exact probability test,and Mann-Whitney U test.The factors with statistically significant differences between sepsis group and non-sepsis group,death group and survival group were selected for binary multivariate logistic regression analysis,so as to screen the independent risk factors affecting sepsis and death in TEN patients.Results Of the 46 TEN patients,30 were male and 16 were female,aged from

关 键 词：表皮坏死松解症 中毒性 脓毒症 预后 影响因素 

分 类 号：R644[医药卫生—外科学] R274.3[医药卫生—临床医学] R654.3