| ObjectiveIn hospitalized patients with drug eruption laboratory index statistics analysis,summed up the characteristics of drug eruption patients early laboratory index,the risk factors for severe drug eruption and correlation between the indexes,explore the diagnosis,treatment and prognosis of severe drug eruption biomarker for judgment,and analysis of the TCM syndrome type of hospitalized patients with drug eruption early distribution characteristics and the same kind of drug eruption patients induced by drugs of TCM symptoms distribution characteristics.MethodCollected the case data of patients with drug eruption who were hospitalized in the dermatology department of our hospital from2012.6.1-2017.9.30.Use Excel to analyze the age,gender,type of rash,dialectical classification of TCM,early laboratory tests including blood routine,liver and kidney function,Electrolytes,myocardial enzymes,erythrocyte sedimentation rate,C-reactive protein,procalcitonin,D-Dimer,total IgE,coagulation function,humoral immunity,cytokines,length of hospital stay,and hospitalization expenses were counted.Statistical analysis was performed on the above indicators using the SPSS 24.0 softwarepackage.Result1.Analysis of the basic situation of 728 patients with drug eruptionThe ratio of male to female in 728 patients with drug eruption was 1:1.54.The gender difference between severe drug eruption and non-severe drug eruption was statistically significant(Z=8.249,P=0.004).The age range of patients with severe drug eruption was 4~86 years old,and that of patients with non-severe drug eruption was 2~94 years old.There was no significant difference in age between the two groups(P=0.784>0.05).Among the patients with non-severe drug eruption,the top three were rash-type drug eruption,urticaria and angioedema,and polymorphic erythema.The patients with severe drug eruption were AGEP,SJS,and DRESS.The length of hospital stay and hospitalization cost of patients with severe drug eruption were significantly higher than those without severe drug eruption,with statistically significant differences(Z=-5.224/-9.404,P=0.000).There was no statistically significant difference in the number of days and the cost of hospitalization between AGEP,SJS,ED and DRESS.2.Comparative analysis of clinical characteristics and laboratory indexes of drug eruption patientsFever and mucosal damage were most common in drug eruption patients.In severe drug eruption,the highest proportion of fever was TEN(100%),followed by DRESS(86.7%),and the highest proportion of mucosal damage was SJS(100%).White blood cells(56.0%),mononuclear cells(55.2%)and leukocytes(56.0%)were the most abnormal indexes in the bloodroutine of patients with early severe drug eruption.Further statistical analysis showed that WBC,N%,N,M and NLR of the patients with severe drug eruption in the early blood routine examination on admission were higher than those without severe drug eruption,and the difference was statistically significant(P<0.05).There was no significant difference between RBC,HGB,PLT,L,EOS and PLR(P>0.05).After treatment,RBC,HGB,N%,NLR and PLR of patients with severe drug eruption were decreased compared with those on admission,and the difference was statistically significant(P<0.05).PLT and L were significantly higher than before admission(P<0.05).WBC,N,M and EOS did not change significantly compared with that on admission(P>0.05).After treatment,RBC,HGB and PLR of the patients with non-severe drug eruption were decreased compared with those on admission,and the difference was statistically significant(P<0.05).WBC,PLT,N,L and M were significantly higher than those at admission(P<0.05).N%,EOS and NLR did not change significantly compared with that on admission.After hospitalization,WBC and N in patients with severe drug eruption were higher than those in patients without severe drug eruption,and the difference was statistically significant(P<0.05).RBC,HGB,PLT,N%,L,M,EOS,NLR,PLR had no significant difference(P>0.05).Patients with severe drug rash and patients with non-severe drug rash accounted for 11.1% and 12.8% of urine routine occult blood positive,19.8% and 11.1% of urine protein positive,and 11.9%and 5.6% of fecal occult blood positive,respectively.The proportion of elevated AST in hepatic enzymes of patients with early drug eruption on admission was higher than that of ALT,and the proportion of severe drug eruption was higher than that of non-severe drug eruption.Further statistical analysis showed that ALT,AST,?-GT and ALP were higher in patients with early severe drug eruption than in patients without severe drug eruption,with statistically significant difference(P<0.05).TP,ALB,DBIL and IBIL were lower in patients with severe drug eruption than in patients without severe drug eruption(P<0.05).There was no significant difference between GLO,TBIL and TBA(P>0.05).Renal dysfunction was mainly caused by elevated BUN,29 cases of severe drug eruption and 55 cases of non-severe drug eruption.Further statistical analysis showed that there were no significant differences in BUN,Cr,Ccr and UA values between the patients with early severe drug eruption and those without severe drug eruption(P>0.05).The highest proportion of patients with severe drug eruption in myocardial zymography was LDH(56.9%),and those with non-severe drug eruption were the most HBDH(81.6%).Further analysis showed that LDH,HBDH and CK-MB were higher in patients with early severe drug eruption than in patients without severe drug eruption,and the difference was statistically significant(P<0.05),while there was no significant difference in CK value between the two groups(P>0.05).There were 32 cases(27.8%)and 29 cases(23.3%)of patients with early severe drug rash admitted to hospital,and 132 cases(22.1%)and 105 cases(17.6%)of patients without severe drug rash.Further statistics showed that the values of sodium and chlorine in the early admission patients with severe drug eruption were lower than those without severe drug eruption,and the difference wasstatistically significant(P<0.05),while there was no significant difference in potassium,calcium,phosphorus and magnesium(P>0.05).Among the D-Dimer,CRP,ESR,PCT,GLU,ASO and total IgE patients admitted to hospital with early drug eruption,the proportion of patients with severe drug eruption with abnormal CRP was the highest(89.6%),followed by D-Dimer(88.4%).The highest proportion of patients with non-severe drug eruption was d-dimer(82.3%),followed by CRP(65.9%).Further analysis showed that CRP and PCT of patients with severe drug eruption were higher than those without severe drug eruption,and the difference was statistically significant(P<0.05).There were no significant differences in D-Dimer,ESR,GLU,ASO,total IgE between patients with severe drug eruption and those without severe drug eruption(P>0.05).The higher proportion of abnormal blood coagulation in patients with early drug eruption was FDP,ATIII and FIB.The results of further analysis showed that the PT and INR values of patients with severe drug eruption were higher than those of non-severe drug eruption,the difference was statistically significant(P<0.05).TT There was no significant difference between FIB,APTT,PT,FDP and ATIII(P>0.05).In humoral immune function,IgM of severe drug eruption decreased by 100%,and C3 of non-severe drug eruption decreased by the highest rate.The highest percentage of abnormal increase in TNF-? was found in cytokine test,with 100% for severe drug eruption and 95.2% for non-severe drug eruption,followed by IL-10 and IL-6.Further analysis showed that the IgG and IgM of patientswith early severe drug eruption in hospital were significantly lower than those without severe drug eruption,and the difference was statistically significant(P<0.05).There was no significant difference in IgA,C3,C4,IL-6,IL-8,IL-10,IL-1? and TNF-?.Both patients with severe drug eruption and non-severe drug eruption had a certain proportion of bacterial and viral infection,but the sequence and mechanism of infection and drug eruption were unclear.In the early laboratory test results of severe drug eruption,the abnormal proportions were from the top three to the top three IgM,TNF-?,and CRP,and the non-severe drug eruptions were TNF-?,D-Dimer,and HBDH.Severe drug rash and non-severe drug eruption WBC,N%,N,M,EOS,NLR,ALT,AST,TP,ALB,?-GT,ALP,sodium,chlorine,LDH,HBDH,CK-MB,CRP,PCT,The differences in PT,INR,IgG,and IgM were statistically significant.3.Regression analysis and correlation study of abnormal indicators in laboratory resultsLogistic regression showed that M,EOS,CK-MB,INR,and PCT were risk factors for patients with severe drug eruption,while ALB,IgG,and IgM were protective factors for patients with severe drug eruption.Sperman correlation test was performed on WBC,N,L,M,EOS,NLR,PLR,PCT,ESR,CRP and D-Dimer in the early laboratory examination of drug eruption patients.The results showed that there was a correlation between multiple indexes in the blood routine of drug eruption patients and CRP,ESR,D-Dimer,while there was no significant correlation between PCT and other indexes,which was a relatively independent indicator.4.Early laboratory examination of patients with severe drug eruptionIn the early laboratory examination indexes of 5 different types of severe drug eruption,the highest proportion of abnormal AGEP indexes was TNF-?,followed by CRP,according to the statistical analysis of WBC,N,L,M,EOS,ALT,AST,BUN,Cr,ESR,CRP,PCT,D-Dimer,TNF-?,IL-10 and secretion culture.The highest proportion of abnormal SJS was TNF-?,D-Dimer,followed by CRP.D-Dimer,TNF-? and IL-10 had the highest proportion of ED abnormality,followed by CRP.The highest proportion of abnormal DRESS was TNF-? and IL-10,followed by CRP.D-dimer was the highest indicator of abnormal proportion in TEN,followed by L and CRP.The comparison between the five groups of severe drug eruptions showed that the electrolytes in the SJS patients had higher magnesium(0.89±0.09)than the patients with AGEP(0.83±0.09),and the difference was statistically significant(P=0.039<0.05).There was no significant difference between the remaining indicators.Analysis of blood routine results of patients with five kinds of severe drug eruption showed that the increase of N,M and EOS was mainly mild,while the increase of L was mainly decreased.Patients with AGEP and SJS were mainly affected by the increase of N,while patients with ED and DRESS were mainly affected by the increase of M,and patients with TEN were mainly affected by the decrease of L.The length of hospital stay of patients with increased N was significantly lower than that of patients with decreased L,and the difference was statistically significant(Z=2.307,P=0.021),and there was no significant difference between the other groups.The combined analysis of some blood routine indexes of the five patients with severe drug eruption showed that the patients with severe drug eruption had the most elevated N accompanied by an elevated M,followed by an elevated M accompanied by an elevated EOS,the patients with AGEP and SJS had the most elevated N accompanied by an elevated M,and the patients with ED and DRESS had the most elevated N accompanied by an elevated M and an elevated M accompanied by an elevated EOS.Further analysis of the diagnostic ability of laboratory indexes WBC,N%,N,M,EOS,NLR,CK-MB,CRP,PCT,INR,IgG and IgM in patients with drug eruption revealed that CK-MB had the highest AUC and the highest credibility,and its sensitivity and specificity were 0.600 and 0.887,respectively.Followed by PCT and M.The AUC of EOS was 0.525,P=0.369>0.05,indicating low credibility.5.TCM syndrome differentiation of patients with drug eruptionIn the TCM syndromes of 728 patients with drug eruption,the obstruction of heat and toxin was the most abundant,and the obstruction of heat and toxin was the most abundant in both severe drug eruption and non-severe drug eruption.The first three TCM syndromes of 187 patients with drug eruption caused by a single drug were obstructed by heat toxin(72 cases),wind-heat-accumulated skin(59 cases)and wind-cold external bundle(26 cases).Among them,proprietary Chinese medicines,antipyretic and analgesic drugs,antiepileptic drugs,anti-gout drugs,lincomycin and other drugs resulted in drug eruptions with the most heat-obstructed type,and penicillin,cephalosporin and nitrofuran drugs resulted in the mostapoplexy heat-accumulated type.Conclusion1.The ratio of male to female in 728 patients with drug eruption was 1:1.54.Patients with non-severe drug eruption had the most rashes,and patients with severe drug eruption had the most AGEP.2.In severe drug eruption,fever and mucosal damage were the most common,with the highest proportion of fever in TEN patients and the highest proportion of mucosal damage in SJS patients.In the early laboratory examination results of severe drug eruption,the abnormal proportion ranged from high to low in the top three IgM,TNF-?,CRP,and in the order of non-severe drug eruption were TNF-?,d-dimer,and HBDH.WBC,N%,N,M,EOS and NLR of patients with severe drug eruption were all higher than those without severe drug eruption.The elevation of liver enzymes in patients with drug eruption is mainly AST,and the abnormal renal function is mainly caused by elevated BUN.The highest proportion of abnormalities in myocardial enzymes in patients with severe drug eruptions is LDH,and patients with non-severe drug eruptions have the most HBDH.The reduction rate of potassium and calcium in patients with severe drug eruption was higher than that in patients without severe drug eruption.CRP and PCT were higher in patients with severe drug eruption than in patients without severe drug eruption,and no significant difference was found between the groups of D-Dimer,ESR,GLU,ASO and total IgE.PT and INR in severe drug eruption patients were significantly higher than that in non-severe drug eruption patients.The decrease rate of IgM in severe drug eruption was 100%,and C3 was the highest in non-severe drug eruption.The highest proportion of abnormal increase in TNF-? was found in cytokinedetection.3.Logistic regression analysis showed that M,EOS,CK-MB,INR,and PCT were risk factors for patients with severe drug eruption,while ALB,IgG,and IgM were protective factors for patients with severe drug eruption.The correlation test of some indexes in the early laboratory examination of drug rash patients showed that there was a significant correlation between the multiple indexes in the blood routine of drug rash patients and CRP,ESR and D-Dimer,while the correlation between PCT and other indexes was not obvious,which was a relatively independent index.4.In the blood routine of patients with five kinds of severe drug eruption,the increase of N,M and EOS was mainly mild,while the increase of L was mainly decreased.Patients with AGEP and SJS were mainly affected by the increase of N,while patients with ED and DRESS were mainly affected by the increase of M,and patients with TEN were mainly affected by the decrease of L.The length of hospital stay of patients with increased N was significantly lower than that of patients with decreased L,and the prognosis of patients with decreased lymphocyte was worse than that of patients with increased neutrophil count.Combined analysis of some blood routine indexes of the five patients with severe drug eruption showed that in the patients with severe drug eruption,increased N accompanied by increased M was the most,followed by increased M accompanied by increased EOS.5.Part of the laboratory for patients with drug eruption refers to plotting the ROC curve and calculating the area under the curve(AUC).The results show that CK-MB has the highest AUC and the highest reliability,and its sensitivity and specificity are 0.600 and 0.887,respectively.Followed by PCT and M.EOS has an AUC of0.525,P=0.369>0.05,and the reliability is low.6.In both severe and non-severe drug eruptions,the obstruction of heat toxin was the most.The first three TCM syndromes of 187 patients with drug eruption caused by a single drug were obstructed by heat toxin(72 cases),wind-heat-accumulated skin(59 cases)and wind-cold external bundle(26 cases).Drug eruption caused by proprietary Chinese medicine,antipyretic analgesics,antiepileptic drugs,gout drugs,lincomycin and other drugs presented the most obstructive type of heat toxin,while drug eruption caused by penicillin,cephalosporins and nitrofurans presented the most heat accumulation type. |
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