Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Predictive Factors Associated With Acute Ocular Involvement in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
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DOI：
10.1016/j.ajo.2015.05.002
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发表时间：
2015-08-01
影响因子：
4.2
通讯作者：
Hashimoto, Koji
中科院分区：
文献类型：
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作者：
Sotozono, Chie;Ueta, Mayumi;Hashimoto, Koji
目的：提出Stevens-Johnson综合征(SJS)和中毒性表皮坏死松解症(TEN)急性眼部严重程度的客观评分，并确定眼表上皮细胞缺陷和/或假膜形成等严重急性眼部损害的预测因素。设计：回顾性队列研究。方法：回顾2005-2007年间SJS(n=87)和10(n=48)患者的病历。根据充血、角膜或结膜上皮缺损和假膜形成的存在情况，从0到3(无、轻度、重度和非常严重)确定急性眼部严重程度评分。结果：87例SJS患者中0、1、2、3级分别为19例(21.8%)、31例(35.6%)、22例(25.3%)、15例(17.2%)；48例中12例(25.0%)、11例(22.9%)、17例(35.4%)、8例(16.7%)。多因素Logistic回归分析显示，年龄(优势比[OR]0.98；95%可信区间[CI]0.96 0.99；P=0.007)和服用非甾体抗炎药或感冒药(OR=2.58；95%CI，1.26~5.29；P=0.010)是严重急性眼部损害的预测因素。视力障碍和眼干的患病率随着急性眼病严重程度的增加而增加(SJS患者分别为P=.001和P=.007；TEN患者分别为P=.007和P=.014)。结论：在SJS/TEN发病时，应严格关注年轻患者和接触非类固醇抗炎药或感冒药的患者的眼部损害。((C)2015年，爱思唯尔公司。保留所有权利。)
PURPOSE: To suggest an objective score for grading the acute ocular severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and to determine predictive factors for severe acute ocular involvement such as ocular surface epithelial defect and/or pseudomembrane formation.DESIGN: Retrospective cohort study.METHODS: The medical records of SJS (n = 87) and TEN (n = 48) patients between 2005 and 2007 were reviewed. An acute ocular severity score was determined on a scale from 0 to 3 (none, mild, severe, and very severe) according to the existence of hyperemia, corneal or conjunctival epithelial defect, and pseudomembrane formation. The associations between the severe acute ocular involvement and factors such as patient age, exposed drugs, systemic severity, and the prevalence of ocular sequelae were examined.RESULTS: The number of cases with score grade 0, 1, 2, and 3 was 19 (21.8%), 31(35.6%), 22 (25.3%), and 15 (17.2%) in 87 SJS cases and 12 (25.0%), 11(22.9%), 17 (35.4%), and 8 (16.7%) in 48 TEN cases. Multivariate logistic regression analysis revealed that patient age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96 0.99; P = .007) and nonsteroidal anti-inflammatory drugs NSAIDs or cold remedies (OR, 2.58; 95% CI, 1.26-5.29; P = .010) were predictive factors for severe acute ocular involvement. The prevalence of visual disturbance and eye dryness increased according to the increase of acute ocular severity (P = .001 and P = .007 in SJS; P = .007 and P = .014 in TEN, respectively).CONCLUSIONS: At the onset of SJS/TEN, strict attention should be paid to ocular involvement in young patients and in patients exposed to NSAIDs or cold remedies. ((C) 2015 by Elsevier Inc. All rights reserved.)