| Objective: To analyze the predisposing factors,clinical characteristics,test results,complications,severity,and treatment methods of the 24 cases of toxic epidermal necrolysis(TEN),so as to improve the understanding of the disease,and to provide references for the treatment.Methods: A retrospective study was performed on 24 patients who were diagnosed with TEN and hospitalized in XX hospital through the past 10 years.The clinical data of the patients were collected and analyzed.SCORTEN score and expected death number were calculated based on the data.The patients were divided into the group treated with glucocorticoid monotherapy,and the group treated with glucocorticoid combined with intravenous immunoglobulin(IVIG).The efficacy of therapeutic modalities was assessed by the following parameters: the fever relief time,the period of lesion improvement and the course of glucocorticoid before reduction to the maintenance does.Results: 1.A total of 24 patients were identified in this study,of which the male to female ratio was 1:1;Excluding 2 children,the average age of onset was 53.04 ± 21.26 years old.2.6 patients(25%)had a history of drug allergy in this study,the agents were mainly penicillin.3.There were 9 patients(79.17%)with previous underlying diseases,mainly including hypertension,renal insufficiency,cerebral hemorrhage,and diabetes.4.20 patients(83.33%)had a positive history of medication before the onset,the main causative agents were antibiotics(62.5%)and antipyretic analgesics(33.33%).Among them,cephalosporins and penicillins were the most common antibiotics.5.Clinical manifestations: The initial symptoms mainly presented erythra and fever,which were 12 cases(50%)and 8 cases(33.33%),respectively.All of the 24 patients had mucosal involvement,the proportion of oral mucosa,ocular mucosa and vulvar mucosa were 66.67%,62.5%,45.83%,respectively.6.Laboratory examination mainly showed abnormal blood routine,liver and kidney dysfunction,electrolyte disturbances,hypoproteinemia,and elevated fasting blood glucose.The bacteria culture of skin secretions mainly showed Staphylococcus aureus and Staphylococcus epidermidis.7.Complications: In the study,pneumonia occurred in 3 patients(12.5%);steroid hypertension occurred 3 patients(12.5%);steroid diabetes occurred 1 patients(4.17%);nerve excitement occurred 1 patient(4.17%);vaginal adhesions occurred 1 patient(4.17%);urinary tract infection occurred 1 patient(4.17%);peritonitis occurred 1 patient(4.17%).8.Mortality: According to the SCORTEN,we calculated the total expected death was 4.9 cases,while the actual death was 2 cases(P> 0.05).9.Treatment: 22 patients were treated with glucocorticoids,of which 16 cases were treated with pulsed high-dose(Group I)while 6 cases received conventional dose(Group II).The days of the fever relief were 4.31±2.67 and 4.67±1.86(P=0.178),the days of the improvement of lesions were 6.31±4.13 and 6±5.25(P=0.319),the days before maintenance dose of glucocorticoid were 7.31±2.36 and 6.5±2.59(P=0.874).Comparing to the conventional dose,the therapy of pulsed high-dose glucocorticoid could not significantly reduce the time of the fever relief,the period of lesion improvement,or the course of glucocorticoid before reduction to the maintenance dose(P>0.05);7 patients were treated with glucocorticoid monotherapy(Group GC),while 15 patients were treated with glucocorticoid combined with IVIG(Group GC+IVIG).The days of the fever relief were 3.71±1.98 and 4.73±2.63(P=0.273),the days of the improvement of lesions were 5.42±4.83 and 6.21±4.50(P=0.838),the days before maintenance dose of glucocorticoid were 7.14±3.48 and 7.07±1.83(P=0.052).Comparing to glucocorticoid monotherapy,glucocorticoid combined with IVIG could not significantly reduce the time of the fever relief,the period of lesion improvement,or the course of glucocorticoid before reduction to the maintenance dose(p>0.05);Administration with IVIG within the first 3 days of hospitalization could effectively reduce the fever relief time(P=0.027),but failed to significantly shorten the period of lesion improvement and the course of glucocorticoid before reduction to the maintenance dose(P> 0.05).Conclusion: 1.The main causative agents of TEN are antibiotics and antipyretic analgesics,antibiotics mainly include cephalosporins and penicillins.2.Erythra is the most common initial symptom,in addition fever and mucosal lesions,etc.The most common mucosal lesions are oral,eye and vulva in turn.3.There is no laboratory index of specific diagnostic value in the case of TEN.Besides,TEN may be accompanied by multiple organ damage.A variety of complications can occur during the treatment,such as secondary infections,steroid hypertension and diabetes,etc.4.SCORTEN score can help predict the expected mortality.5.Comparing to the conventional dose glucocorticoid therapy,the therapy of pulsed high-dose glucocorticoid could not significantly reduce the fever relief time,the period of lesion improvement or the course of glucocorticoid before reduction to the maintenance dose;Comparing to glucocorticoid monotherapy,the glucocorticoid combined with IVIG therapy could not significantly reduce the fever relief time,the period of lesion improvement or the course of glucocorticoid before reduction to the maintenance dose;Treatment with IVIG within the first 3 days of hospitalization could effectively reduce the fever relief time,but failed to significantly shorten the period of lesion improvement and the course of glucocorticoid before reduction to the maintenance dose. |
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