Toxic Epidermal Necrolysis: Performance of SCORTEN and the Score-Based Comparison of the Efficacy of Corticosteroid Therapy and Intravenous Immunoglobulin Combined Therapy in China
Toxic Epidermal Necrolysis: Performance of SCORTEN and the Score-Based Comparison of the Efficacy of Corticosteroid Therapy and Intravenous Immunoglobulin Combined Therapy in China
复制标题
中毒性表皮坏死松解症：SCORTEN 的表现以及中国皮质类固醇治疗与静脉注射免疫球蛋白联合治疗疗效的评分比较
DOI：
10.1097/bcr.0b013e318254d2ec
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发表时间：
2012-11-01
影响因子：
1.4
通讯作者：
Huang, Hui-yuan
中科院分区：
文献类型：
--
作者：
Zhu, Qin-yuan;Ma, Li;Huang, Hui-yuan
中毒性表皮坏死松解症(TEN)是与药物有关的最严重的皮肤疾病，在没有成熟的治疗方法的情况下，可能会危及生命。皮质类固醇治疗的应用存在争议，而静脉注射免疫球蛋白(IVIG)是近年来出现的一种很有前途的新方法。在一些西方国家，疾病严重程度评分(SCORTEN)已经被接受。在这项研究中，我们的目标是评估SCORTEN在中国TEN患者中的适用性，并评估IVIG和皮质类固醇联合治疗这些患者的疗效。我们对2000年至2010年在我们重症监护病房接受治疗的61名患者的数据进行了回顾性回顾，以评估SCORTEN的表现。特别是，2002年至2010年间的55名患者被分组为一系列，以比较皮质类固醇治疗和静脉注射免疫球蛋白联合治疗的疗效。在此期间，16例患者接受了皮质类固醇治疗，39例患者接受了联合治疗。所有10例患者均给予甲基强的松龙1.5 mg/kg/d的起始剂量。联合用药5d内给予静脉注射丙种球蛋白2g/kg。分析了接收器工作特性曲线和Hosmer-Lemesow统计量下的面积，以说明SCORTEN的性能。在临床结果、标准化死亡率(SMR)和生存分析的基础上对两种疗法的疗效进行比较。2000年至2010年间患者的总体实际死亡率为16%(10/61)，但在统计学上没有显著低于预测(24%，SMR=67.98)。各组的识别力均较好(受试者工作特征曲线下面积分别为88.9、88.2、90.6%)，校正良好(P=.637、.833、.530)。在2002年至2010年间入院的患者中，静脉注射丙种球蛋白联合治疗有降低死亡率的趋势(13%，SMR=52.35)，而单用皮质类固醇治疗则无此差异(31%，SMR=123.92)。此外，联合治疗的累积生存率几乎在所有SCORTEN水平上都较高(P=0.002)，特别是在5分时(P=3.10×10−7)。与单独使用皮质类固醇相比，联合治疗可以更早地阻止病情进展(P=.013)，尽管它并没有显著导致皮质类固醇的减少或住院时间的减少。我们的结论是SCORTEN一般适用于中国人的TEN。疗效比较表明，联合治疗较单用糖皮质激素有更好的疗效，尤其是对重症患者。
Toxic epidermal necrolysis (TEN) represents the most severe drug-related skin condition that is potentially life-threatening with no well-established treatments. The application of corticosteroid therapy is controversial, whereas recently intravenous immunoglobulin (IVIG) therapy is emerging as a promising new method. A severity-of-illness score for TEN (SCORTEN) has gained acceptance in some western countries. In this study, our objectives were to assess the applicability of SCORTEN in Chinese patients with TEN and to evaluate the efficacy of the combination therapy of IVIG and corticosteroid in these patients. We performed a retrospective review of data from 61 patients with TEN treated at our intensive care unit from 2000 to 2010 to assess the performance of SCORTEN. In particular, 55 patients between 2002 and 2010 were grouped as a series to compare the therapeutic effects of corticosteroid therapy and IVIG combined therapy contemporaneously. During this period, 16 patients were administered with corticosteroid therapy and 39 were treated with the combination therapy. An initial dose of 1.5 mg/kg/day of methylprednisolone was given to all TEN patients. The combination therapy was combined with a total dose of 2 g/kg IVIG within 5 days. Areas under receiver operating characteristic curves and Hosmer-Lemeshow statistic were analyzed to illustrate the performance of SCORTEN. The comparison of the efficacy of the two therapies was conducted on the basis of clinical outcomes, standardized mortality ratio (SMR), and survival analysis. The overall actual mortality of patients between 2000 and 2010 was 16% (10/61), statistically insignificantly lower than predicted (24%, SMR = 67.98). Excellent discriminatory power (the areas under the receiver operating characteristic curves: 88.9, 88.2, 90.6%) and good calibration (P = .637, .833, .530) were found in all the groups. In patients admitted between 2002 and 2010, IVIG combined therapy showed a trend toward reducing the mortality rate (13%, SMR = 52.35), whereas corticosteroid monotherapy suggested no such difference (31%, SMR = 123.92). Besides, the cumulative survival rates of the combination therapy were higher at almost all the levels of SCORTEN (P = .002), especially at the score of 5 (P = 3.10 × 10−7). Compared with corticosteroid alone, the combination therapy arrested progression earlier (P = .013), although it did not significantly lead to a tapering of corticosteroid or a reduction of the time of hospitalization. We concluded that SCORTEN was generally applicable to Chinese patients with TEN. The comparison of the effect indicated that the combination therapy might achieve a better therapeutic effect than the administration of corticosteroid alone, especially in severe TEN patients.