Epidemiological Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Retrospective Analysis of Southern Taiwanese Population During 2002 to 2007

史帝文強生症候群及毒性表皮溶解症：南台灣病人流行病學回溯性研究

黃菁馨(Chin-Hsin Huang) ； 何宜承(Ji-Chen Ho) ； 鄭裕文(Yu-Wen Cheng) ； 吳唯銘(Wei-Ming Wu) ； 黃晟霖(Shen-Lin Huang) ； 王振宇(Cheng-Yu Wang)

《中華皮膚科醫學雜誌》 27卷1期 (2009/03) Pp. 15-26

https://doi.org/10.29784/DS.200903.0002

摘要

背景：史蒂文強生症候群及毒性表皮溶解症是嚴重且致命性的藥物不良反應。目前對最合適的治療方式仍有爭議。在台灣此類疾病的流行病學資料仍然有限。
目的：評估全身類固醇療法對史蒂文強生症候群及毒性表皮溶解症的療效，進一步也重新統計該疾病相關的流行病學資料。
方法：本研究回溯性地收集本院過去五年內符合診斷的住院病例，評估分析全身性類固醇的治療效果，此外也統計所有病例的死亡率、併發症以及最常見的致病藥物種類。
結果：一共蒐集了52個病例；其中10位分類為毒性表皮溶解症、其它42位為史蒂文強生症候群。整體的死亡率為3.8%，住院中相關的感染併發症為23%。在常見引發的藥物方面，抗癲癇藥物（特別是carbamazepine）為最常見，依次為非類固醇止痛藥、降尿酸藥及抗生素。研究中顯示早期類固醇投與治療的確較支持性療法可以縮短住院天數(p=0.012)。
結論：治療上早期類固醇投與治療的確有幫助，特別是減少發炎及減緩疾病的進展方面，而感染的併發症在投予類固醇治療的病人中格外需要注意。

並列摘要

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reaction with potentially life-threatening skin disease. The widely accepted consensus regarding therapy does not exist at present and epidemiological data of Taiwan in recent years is limited.
Objective: To evaluate the efficacy of systemic steroid therapy in treatment of SJS and TEN and also analysis the associated epidemiology data.
Methods: This study was performed by retrospectively chart review of patients admitted with SJS or TEN in a tertial referral medical center in southern Taiwan between 2002 and 2007. Clinical data including mortality, morbidity, the category of offending drugs and the systemic steroid treatment effects were analyzed.
Results: Total 52 patients were included; 10 were classified as TEN and 42 as SJS. Overall mortality is 3.8% and infectious morbidity is 23%. In aspect of causative agents, anticonvulsants (especially carbamazepine) were the most common drugs followed by Non-Steroid Anti-inflammatory Drugs, allopurinol and antibiotics in our series. Early systemic steroid administration may shorten the hospitalization duration than supportive care (p＜0.012) in our study.
Conclusion: In our study, early administration of systemic steroids maybe benefits in the forms of inflammation prevention and disease progression. Short-term use to preclude infection morbidity, as well as a tapering dose as soon as possible, is suggested.

並列關鍵字

Stevens-Johnson syndrome SJS ； Toxic epidermal necrolysis TEN ； Clinical outcome ； Systemic steroid