| ObjectiveIn order to improve the diagnosis and treatment level of severe drug eruption in Jiangxi province,we choose 2 time periods to analyze the clinical data of the patients with SDE in the Second Affiliated Hospital of Nanchang University to find the epidemiology and diagnosis and treatment characteristics of SDE in recent 20 years.MethodsWe choose 1999-2004,2012-2017 years as two time periods.,and then collected the medical records of the patients with SDE in Department of dermatology at the Second Affiliated Hospital of Nanchang University.We described the age,the sex,the cause of drug use,the inspection index,treatment(include the dose of Glucocorticoid,IVIG,Selection of Antibiotic and antiallergic drugs),time of hospitalization and prognosis.Finally,we aggregate the data and carry out statistical analysis.Results1.General information: 26 cases of severe drug eruption in early group,and 78 cases of severe drug eruption in recent years.The portion of men and women in early age group was 1.17:1,and 1.29:1 in recent years.The average age was 32 years old in early group and 51 years old in recent years.The largest age of the two groups was the exfoliative dermatitis(ED,exfoliative dermatitis),the average age was 40.1 and 64.4.2.Causes of drug use and sensitized drugs: The top three causes of severe drug eruption was infection,epilepsy and pain in the the early group.The infection rate,gout and pain were the top three causes in recent years.The top three of sensitized drugs were antibiotics,antiepileptic drugs,antipyretic analgesics in early group,and there were antibiotics,antiepileptic drugs,allopurinol in recent years.3.Clinical symptoms: Itching was the most common symptom in two groups of SDE,and ED group was the most.Mucosal damage was ranked second in the two groups,and the most common was oral cavity.SJS and TEN had more mucosal involvement than the other three groups.Third common symptoms were pain in early group(38.5%),fever in recent group(53.8%)4.Inspection index: The top three abnormal inspection index of early group were WBC count,NE% and AST,the liver dysfunction were most commonly seen in ED,followed by TEN,and renal function abnormalities were most common in ED.The top three of recent group were NE%,ALT,and WBC count.The other four groups had higher liver enzyme abnormalities than those from high to low: ED,TEN,SJS and respectively.The most abnormal indicators of BUN and Cr were seen in ED.The most cases of bacterial culture of wound(+)was found in TEN.The decrease of blood potassium was found most in AGEP.5.Incubation period: The average incubation period of the early groups was 12.73 days,of which the ED type latent period was the longest(16.27)and the AGEP type was the shortest(1.33);the recent group had the average latent period of 11.14 days,the longest latent period was still ED(18.88 days),and the AGEP was the shortest(1.71 days).The results are basically the same.6.Hospitalization time:The average hospitalization time was 13.08 days in early group,and 11.31 days in recent group.The average time in TEN was the longest,and the early group and the recent group were 16.17 and 15.38 days.The average hospitalization of AGEP was the least,as early group was7.36 days and 4.67 days respectively in recent group.7.Complication: The most common complication of early group was drug induced hepatitis(30.8%),pulmonary infection and nephritis were also more common(all 7.7%),and the ED group had the most complications.The top three of recent group were drug-induced hepatitis(51.3),drug nephritis(19.2%),pulmonary infection(15.4%),and type SJS complication more than the other four types,with 41 cases.The highest incidence of drug-induced hepatitis and drug-induced glomerulonephritis groups were ED type.8.Treatment: In the early group,25 cases were treated with glucocorticoid.The initial average dose(calculated by methylprednisolone)was 57.2mg/d,and the ED type was the most in the total amount,initial dose and reduction time.In the recent groups,66 cases were treated with corticosteroids,the initial average dose was 52.33mg/d,and the initial average dose of type TEN severe drug eruption was the largest,which was 66.4mg/d.The difference was statistically significant compared with the other 4 groups;the logest time of glucocorticoid reduction of ED was the longest.AGEP was the lowest in the two groups.There were no cases used IVIG treatment in early group,as There were only 2 cases used IVIG in recent group,all of them were TEN.There were 3 cases used antibiotics in early group and 19 cases in recent group,and SJS and TEN group had more cases used antibiotics than the other 3 groups.The most commonly used antibiotics were macrolides,followed by quinolones.9.Prognosis: In the 26 cases of early group,22 cases were improved,3 cases were not healed,1 cases were discharged automatically,of which the rate of ED improvement was the lowest;78 patients in the recent group were improved in 62,14 unhealed and 2 discharged automatically;the improvement rate of SJS and AGEP was significantly higher than that of TEN and ED type(P<0.05).The DRESS improvement rate was the lowest.10.SCRTEN score: The TEN of the early groups and the recent groups were all higher than SJS,which were statistically different.Conclusion1.SDE in Jiangxi province showed a significant upward trend in recent 5 years.There was no significant difference in the incidence of male and female,and the risk increased over the age of 50 years.Infection is the main cause of severe drug eruption,antibiotics are the primary sensitizing drugs,and the rest are psychotropic drugs,antipyretic and analgesic drugs.Allopurinol has increased the number of sensitized cases in the last 5 years.2.Itching is the most common symptom of SDE,followed by mucosal damage,among which mouth involvement is the most common.The SJS and TEN type of SDE is more obvious than other types in the mucosal damage.3.Abnormal white blood cell index and liver and kidney function damage are the most unusual test indexes of SDE,in which liver function abnormality is common except for the other four types of AGEP,ED type is easily damaged by liver and kidney function,TEN type of wound often occurs secondary bacterial infection,and AGEP is only the increase of WBC count.4.In the last 20 years,the longest time for hospitalization was the TEN type of SDE.The longest latent period was ED.On the prognosis,ED was the worst,TEN was the next,and the prognosis of AGEP was the best.5.The most common complication in recent 20 years is drug~induced liver and kidney damage,secondary is infection.Drug hepatitis is prone to all kinds of SDE except AGEP,of which ED type is easy to combine with liver and kidney damage,and TEN type is the most likely to be associated with infection.6.Early sufficient glucocorticoid therapy is very necessary for SDE.It is recommended to use moderate dose methylprednisolone(40-50mg/d).At the beginning of 21 th Century,the ED type had the longest time and largest dose of glucocorticoid therapy.However,in the latest 5 years,it is mainly the TEN type,but the ED type is still in the second place.These 2 types of SDE were needed to pay more attention to the side effects caused by long term treatment.SJS needs detailed assessment.AGEP can be reduced rapidly relatively.IVIG has a certain effect,but the price is high and it is difficult to popularize.The use of antibiotics should be cautious,macrolides and quinolones maybe recommended for their relative less sensitization. |
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