糖皮质激素和免疫球蛋白治疗中毒性表皮坏死松解症疗效分析

摘要

目的：对系统使用糖皮质激素（激素）和静脉注射免疫球蛋白（IVIG）治疗中毒性表皮坏死松解症（TEN）的疗效进行评价。方法收集2006年1月至2012年12月收住院的TEN患者治疗反应的资料，采用SPSS软件包对数据进行多元线性回归，二元Logistic回归以及Cox回归分析。结果随年份的增加，激素最大控制用量逐渐减少（β=-0．461，P=0．004），然而IVIG的使用率和年份无显著关系。随IVIG使用率的增加，住院时间（RR=0．351，95．0％CI：0．150~0．825）和皮损控制时间（RR=0．492，95．0％CI：0．245~0．986）均逐渐缩短；随最大激素用量的增加，皮损控制时间逐渐缩短（RR=0．997，95．0％CI：0．994~1．000），而与住院时间无相关性。结论IVIG的使用对控制患者皮损，减少并发症及综合改善患者预后有优势，与激素相比，IVIG的疗效更显著、不良反应较小，可优先选择。%Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.