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目的分析重症多形红斑(SJS)和中毒性表皮坏死松解症(TEN)的致病因素、临床特征及治疗与转归,为其临床防治提供依据。方法回顾性分析杭州市第三人民医院收治的73例SJS和TEN患者的临床资料,其中34例采用注射用甲泼尼龙琥珀酸钠联合静脉用人丙种球蛋白针(A组),39例采用注射用甲泼尼龙琥珀酸钠联合血液透析进行治疗(B组);对其一般资料、致病因素、临床特征、实验室检查结果及治疗与转归进行总结。结果 58例患者有明确病因,其中57例为药物所致,占98.3%;致敏药物以别嘌呤醇和卡马西平为主,分别占34.5%、24.1%。SJS和TEN患者的常见临床特征为体温升高、电解质紊乱、白细胞、肝酶、尿素氮升高,发生率均在30%以上,也有部分伴有血糖升高者,发生率为20.5%;总病原菌检出率91.8%,其中皮肤病原菌检出率最高,占83.6%,菌种主要是金黄色葡萄球菌,占61.6%。A、B两组退热时间、住院时间、死亡率差异无统计学意义(P>0.05),A组费用较低,差异有统计学意义(P<0.05)。结论本地区近2年引起SJS和TEN的常见药物为别嘌呤醇和卡马西平,在对症治疗的基础上,糖皮质激素联合静脉用人丙种球蛋白针或糖皮质激素联合血液透析均能取得较好疗效。
Objective To analyze the pathogenic factors, clinical features, treatment and prognosis of severe polymorphic erythema (SJS) and toxic epidermal necrolysis (TEN) and provide the basis for their clinical prevention and treatment. Methods The clinical data of 73 patients with SJS and TEN admitted to the Third People’s Hospital of Hangzhou were retrospectively analyzed. Among them, 34 patients were injected methylprednisolone sodium succinate and intravenous gamma globulin needle (group A), and 39 patients received injection With methylprednisolone sodium succinate combined hemodialysis treatment (B group); its general information, risk factors, clinical features, laboratory findings and treatment and outcome were summarized. Results 58 patients had a clear cause, of which 57 were drug-induced, accounting for 98.3%. Allopurinol and carbamazepine were the major allergens, accounting for 34.5% and 24.1% respectively. Common clinical features of patients with SJS and TEN are elevated body temperature, electrolyte imbalance, leukocytosis, liver enzymes, elevated levels of urea nitrogen, the incidence was above 30%, and some accompanied by elevated blood sugar, the incidence was 20.5%; total Pathogenic bacteria detection rate of 91.8%, of which the highest detection rate of skin pathogens, accounting for 83.6%, mainly Staphylococcus aureus strains, accounting for 61.6%. There was no significant difference in the time of fever, hospital stay and mortality between groups A and B (P> 0.05). The costs of group A were lower (P <0.05). Conclusions The common drugs of SJS and TEN that cause SJS and TEN in this area are allopurinol and carbamazepine in the past two years. On the basis of symptomatic treatment, glucocorticoid combined with intravenous administration of human gamma-globulin pin or glucocorticoid can achieve better results Efficacy.