Stevens-Johnson综合征/中毒性表皮坏死松解症104例回顾性分析  

Stevens-Johnson syndrome/toxic epidermal necrolysis:a retrospective study of 104 cases

作　　者：胡霞 梁高澎 王欢 邓思思 宋志强 Hu Xia;Liang Gaopeng;Wang Huan;Deng Sisi;Song Zhiqiang(Department of Dermatology,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Dermatology(Medical Aesthetics),People′s Hospital of Liangping District,Chongqing 405200,China)

机构地区：[1]陆军军医大学第一附属医院皮肤科,重庆400038 [2]重庆市梁平区人民医院皮肤(医学美容)科,重庆405200

出　　处：《中华皮肤科杂志》2024年第12期1114-1120,共7页Chinese Journal of Dermatology

摘　　要：目的分析Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)的临床特征,评估TEN严重程度评分(SCORTEN)预测死亡的准确性。方法回顾2003年12月至2023年12月陆军军医大学第一附属医院104例SJS/TEN的临床资料,如致敏药物、临床表现、实验室检查、SCORTEN、治疗方案等,分析不同治疗模式对TEN的疗效差异。采用受试者工作特征曲线(ROC)分析SCORTEN预测TEN患者死亡的准确性。结果104例中,男57例,女47例,年龄12~93(45.45±19.76)岁;其中SJS 52例,TEN 52例(含SJS/TEN重叠1例),SJS患者年龄(40.42±17.06)岁低于TEN患者(50.48±21.13)岁,t=2.67,P=0.009;患者住院时间(14.47±7.24)d,TEN患者住院时间(16.65±7.82)d较SJS患者(12.29±5.92)d更长(t=3.21,P=0.002)。82例有明确致敏药物,其中以联合药物例数最多(26例,25.00%),与抗生素联合用药20例;56例(53.85%)明确单一用药,较常见的致敏药物是卡马西平(16例,15.38%)、非甾体抗炎药(13例,12.50%)和别嘌呤醇(9例,8.65%)。实验室检查结果中,TEN患者淋巴细胞计数降低、丙氨酸转氨酶和/或天冬氨酸转氨酶升高、白蛋白降低、肌酐升高发生率均高于SJS患者(P<0.05),单核细胞计数升高的发生率低于SJS患者(P=0.006)。52例TEN患者中SCORTEN<3分33例,≥3分19例,预计死亡例数12.32例,实际死亡4例;ROC曲线评估SCORTEN预测TEN患者死亡的曲线下面积为0.784(95%CI:0.558~1.00)。104例患者中采用单一治疗方案(仅用糖皮质激素)57例(54.81%),采用联合治疗方案47例(45.19%),其中糖皮质激素联合静脉注射用丙种球蛋白(IVIG)42例。TEN患者中30例启动糖皮质激素治疗7 d内联合IVIG(早期联合组),7例启动糖皮质激素治疗7 d后联合IVIG(晚期联合组),早期联合组的皮损稳定时间(10.82±3.35)d较晚期联合组(15.50±4.04)d更短(LSD-t=2.87,P=0.006)。结论SJS/TEN患者主要致敏原因为与抗生素的联合用药,早期联合糖皮质激素和IVIG可一定程度上缩短TEN患者的病�Objective To analyze the clinical features of Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN),and to evaluate the accuracy of the TEN-specific severity-of-illness score(SCORTEN)in predicting death.Methods A retrospective analysis was conducted on 104 patients with SJS/TEN at the First Affiliated Hospital of Army Medical University between December 2003 and December 2023.Clinical data,such as sensitizing drugs,clinical manifestations,laboratory tests,SCORTEN scores,and treatment regimens,were collected and retrospectively analyzed.The efficacy of different treatment modalities for TEN was analyzed.The receiver operating characteristic(ROC)curve was used to assess the accuracy of SCORTEN in predicting death in TEN patients.Results Among the 104 patients,57 were males and 47 were females,with ages ranging from 12 to 93 years(45.45±19.76 years).There were 52 cases of SJS and 52 cases of TEN(including 1 case of SJS-TEN overlap).The ages of SJS patients(40.42±17.06 years)were significantly lower than those of TEN patients(50.48±21.13 years;t=2.67,P=0.009);the total hospital stay was 14.47±7.24 days,and the TEN patients had significantly longer hospital stays(16.65±7.82 days)compared with the SJS patients(12.29±5.92 days;t=3.21,P=0.002).Definite sensitizing drugs were identified in 82 patients;combined drugs were the most common sensitizing cause(26 cases,25.00%),and 20 patients reported combination treatment with antibiotics;56 patients(53.85%)were treated with single drugs,and the common sensitizing drugs included carbamazepine(16 cases,15.38%),nonsteroidal anti-inflammatory drugs(13 cases,12.50%),and allopurinol(9 cases,8.65%).Laboratory test results showed that the proportions of patients with decreased lymphocyte counts,elevated alanine aminotransferase and/or aspartate aminotransferase levels,decreased albumin levels,and with increased creatinine levels were significantly higher in the TEN patients than in the SJS patients(all P<0.05),while the proportion of patients with increased monocyte

关 键 词：STEVENS-JOHNSON综合征 表皮坏死松解症 中毒性 药疹 临床特征 SCORTEN评分 死亡 治疗 预后 

分 类 号：R758.25[医药卫生—皮肤病学与性病学]