Ye Zhenzhen, Li Chunting, Zhang Hua, Zhang Chunlei, Lu Xueyan
Department of Dermatology, Peking University Third Hospital, Beijing, People's Republic of China.
Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, People's Republic of China.
Clin Cosmet Investig Dermatol. 2022 Sep 19;15:1979-1990. doi: 10.2147/CCID.S378106. eCollection 2022.
To summarise the clinical characteristics of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis syndrome (SJS/TEN) and analyse the efficacy and safety of systemic glucocorticoid therapy.
This study was a retrospective study of 56 patients with SJS/TEN who had been systematically treated with glucocorticoids in the dermatology ward of Peking University Third Hospital from 2010 to 2020. The clinical characteristics, treatment regimen, effects on underlying diseases, incidence and outcome of hormone-related adverse reactions and skin lesion prognosis were summarised and analysed for each patient.
① The allergenic drugs were found to be antibiotics (31.51%), antipyretic and analgesics (21.92%), traditional Chinese medicines and health products (15.07%) and neuropsychiatric drugs (13.70%). ② Based on the 56 patients' scores of toxic epidermal necrosis at admission, the actual mortality rate was 1.8% (1/56), which was significantly lower than the average expected mortality rate of 15.0% (P = 0.032; standardised mortality ratio = 0.13; 95% confidence interval: 0.00-0.53). ③ A total of 33 patients (58.9%) had underlying diseases, of which 10 patients (30.3%) had underlying diseases that fluctuated during treatment but stabilised after symptomatic treatment. ④ During treatment, 73.2% (41/56) of patients had complications that may have been related to systemic glucocorticoids; 97.6% (40/41) had mild symptoms, and 92.7% (38/41) had improved/recovered complications at the time of discharge.
① Antibiotics are still the most common sensitising drugs, and traditional Chinese medicine and health products are also common sensitising drugs. ② Early systemic application of medium- to high-dose glucocorticoids is effective in the treatment of SJS/TEN, and it is beneficial in reducing mortality. ③ The short-term application of medium- to high-dose hormone therapy for SJS/TEN has little effect on underlying diseases. The related complications are mostly mild, and the treatment is safe.
总结史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）患者的临床特征，并分析全身糖皮质激素治疗的疗效和安全性。
本研究为回顾性研究，纳入2010年至2020年在北京大学第三医院皮肤科病房接受糖皮质激素系统治疗的56例SJS/TEN患者。总结并分析每位患者的临床特征、治疗方案、对基础疾病的影响、激素相关不良反应的发生率和转归以及皮肤病变预后。
①致敏药物中抗生素占31.51%，解热镇痛药占21.92%，中药及保健品占15.07%，神经精神药物占13.70%。②根据56例患者入院时的中毒性表皮坏死评分，实际死亡率为1.8%（1/56），显著低于平均预期死亡率15.0%（P = 0.032；标准化死亡率=0.13；95%置信区间：0.00 - 0.53）。③共有33例患者（58.9%）患有基础疾病，其中10例患者（30.3%）的基础疾病在治疗期间波动，但经对症治疗后稳定。④治疗期间，73.2%（41/56）的患者出现可能与全身糖皮质激素有关的并发症；97.6%（40/41）症状轻微，92.7%（38/41）的患者在出院时并发症改善/恢复。
①抗生素仍是最常见的致敏药物，中药及保健品也是常见的致敏药物。②早期全身应用中高剂量糖皮质激素治疗SJS/TEN有效，且有助于降低死亡率。③中高剂量激素短期治疗SJS/TEN对基础疾病影响较小。相关并发症大多轻微，治疗安全。
