Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan.
Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan.
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史蒂文斯 - 约翰逊综合征/有毒表皮坏死的临床方面，台湾严重的眼部并发症。
DOI：
10.3389/fmed.2021.661891
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发表时间：
2021
影响因子：
3.9
通讯作者：
Chung WH
中科院分区：
文献类型：
--
作者：
Ma DH;Tsai TY;Pan LY;Chen SY;Hsiao CH;Yeh LK;Tan HY;Lu CW;Chen CB;Chung WH
目的：在过去十年中，Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（TEN）的治疗取得了巨大进展。为了了解这是否导致更好的眼科结局，我们旨在研究SJS/TEN患者急性和慢性期严重眼部并发症（SOC）的发生率、主要致病药物以及药物和手术治疗的疗效。研究方法：以林口医院分支2010 - 2020年的电子病历资料为基础，对119例（236眼）在急性期接受眼科会诊的患者进行回顾性研究。采用Sotozono的急性和慢性SJS/TEN分级评分系统评估急性和慢性表现之间的相关性、全身依那西普治疗的疗效以及在重度急性SOC患者中进行的早期羊膜移植（AMT）的结局。结果如下：共有46名男性和73名女性患者，平均年龄为45.6 ± 22.7岁（2-90岁），随访时间为408.3 ± 351.0（116- 1，336）天。SJS、重叠综合征和TEN患者数量分别为87、9和23例。共有109只眼（55例患者）发生急性SOC，占接受眼科检查患者的46.2%。抗癫痫药是急性期引起SOC的最常见的罪魁祸首药物。随访结束时，有14只眼（9例患者）患有慢性SOC（5.9%），非甾体抗炎药和感冒药是最常见的与严重慢性后遗症相关的致病药物。Sotozono急性和慢性分级评分之间的相关性显示出正相关[斯皮尔曼等级相关系数（r）= 0.52，p < 0.001]。接受全身皮质类固醇联合依那西普治疗的患者的平均慢性分级评分显著低于仅接受皮质类固醇治疗的患者。最后，在发病后7天内接受AMT的患者的平均慢性分级评分显著低于7天后接受AMT的患者。结论：急性症状可作为慢性后遗症的一个指标。额外的早期依那西普治疗和早期AMT在减少慢性眼部后遗症方面显示出有益的效果。
Purpose: Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment. Methods: Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs. Results: There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2–90 years), and follow-up time of 408.3 ± 351.0 (116–1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient (r) = 0.52, p < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days. Conclusion: Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.
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DOI：
10.1073/pnas.0409500102
发表时间：
2005-03-15
影响因子：
11.1
作者：
Hung, SL;Chung, WH;Chen, YT
通讯作者：
Chen, YT
影响因子：
6.5
作者：
Hsu, Derek Y.;Brieva, Joaquin;Silverberg, Jonathan I.
通讯作者：
Silverberg, Jonathan I.
影响因子：
6.4
作者：
Shanbhag, Swapna S.;Chodosh, James;Saeed, Hajirah N.
通讯作者：
Saeed, Hajirah N.
影响因子：
9.9
作者：
Chen, Chun-Bing;Hsiao, Yi-Hsin;Chung, Wen-Hung
通讯作者：
Chung, Wen-Hung
影响因子：
4.1
作者：
Ma, Kevin Sheng-Kai;Chung, Wen Hung;Ueta, Mayumi
通讯作者：
Ueta, Mayumi