三氯乙烯药疹样皮炎肝损害的临床观察

目的 了解三氯乙烯药疹样皮炎患者的肝损害情况及规律。方法对我院的三氯乙烯药疹样皮炎患者55例(临床分型为：剥脱性皮炎29例，多形红斑22例，重症多形红斑3例，大疱性表皮坏死松解症1例)的肝损害临床表现及肝功能(ALT、AST、GGT、TBA、T-BIL等)和病毒性肝炎标志物(抗-HAV、抗-HCV、HbsAg、HbsAb、HbeAs、HbeAb和HBcAb)的检查进行分析。结果55例患者有肝损害53例，占96．4％。B型超声波检查提示肝、脾肿大23例，占41．8％。病毒性肝炎标志物检查4例HbsAg阳性，余者均为阴性。在治疗过程中随着激素的使用，皮疹逐渐消退肝功能也明显好转，一般一周后好转，平均40—49d痊愈。结论 三氯乙烯药疹样皮炎的肝损害出现率高，且较严重；肝功能损害随着皮疹消退而较快恢复，一般预后较好，但也是造成这类患者死亡的重要原因之一。

A clinical observation on hepatic dysfunction in epispasis-like dermatitis patients due to trichloroethylene

Objective To i nvestigate the ma nifestations and rules of hepatic dysfuc ntion of epispasislike dermatitis patie n ts due to trichloroethylene exposure. Meth od The clinical manifestations,hep atic f unction(ALT,AST,GGT,TBA and TBIL)and bi omarkers of hepatitis A,B,and C viruses( antiHAV,antiHCV,HbsAg,HbsAb,HbeAg,HbeA b and HbcAb)of 55 hospitalized cases(29 exfoli ative dermatitis,22 erythema multiforme, 3 StevensJohnson syndrome,and 1 toxic e pidermal necrolysis)were analyzed. Result 53 cases(96.4%)showed hepa t ic dysfuncti on,23 cases(41.8%)showed hepatomegaly a nd/or splenomegaly,and HbsAg was positiv e in 4 cases.Along with glucocorticoid t reatment,usually one week later,the tetter was beginning to subside and the hepatic function,to improve. The tetter and hepatic function recovere d for approximately 40-49 days.Con cl usion In the epispasislike dermat itis patients due to trichloroethylene ,the hepatic dysfunction was occurre d in high percentage and severity.After treatment,along with the subsidence of t etter,usually the hepatic dysfun ction was beginning to recover quickly,b ut it also may be the main cause of de ath.