Stevens-Johnson综合征或中毒性表皮坏死松解症24例分析

目的探讨Stevens-Johnson综合征（SJS）或中毒性表皮坏死松解症（TEN）急性期的临床特点、眼部表现及治疗。方法回顾性病例研究。对2012年5月-2014年2月于北京协和医院皮肤科确诊为SJS或TEN的24例患者的病史、眼部表现及治疗进行回顾性分析。结果24例患者均由口服药引起，主要致敏药物为抗生素（7例）、解热镇痛药（6例）和神经精神药（4例）。24例患者中16例出现眼部受累，所有眼部受累患者均为双眼受累，13例出现结膜充血，12例出现结膜渗出，9例累及眼睑，7例出现结膜假膜，7例累及睑缘，3例累及角膜。24例患者均接受全身激素治疗，眼部受累患者联合眼部激素治疗，病情较重者辅以免疫抑制剂，眼部分泌物较多者行人工泪液冲洗，必要时分离睑球粘连。结论SJS或TEN急性期可表现为不同程度的皮肤及黏膜损害，多伴眼部受累，全身和局部足量的糖皮质激素治疗可控制病情发展，减轻眼部损伤。

Retrospective analysis of twenty-four cases of Stevens-Johnson syndrome or toxic epidermal necrolysis

ObjectiveTo analyze the clinical characteristics of the ocular symptoms and treatment for Stevens-Johnson syndrome （SJS） or toxic epidermal necrolysis （TEN） induced by using drugs. MethodsA retrospective analysis was undertaken of all patients admitted between May 2012 and February 2014 in Peking Union Medical College Hospital with a diagnosis of SJS or TEN. ResultsA total of 24 patients with SJS or TEN were consecutively recruited. Of the 24 patients， antibiotics （7 patients）， antipyretic analgesics （6 patients） and antipsychotics （4 patients） were the main drugs causing ocular symptoms. Ocular involvement was noted in 16 patients. Of the 16 patients with ocular involvement， all of them had bilateral lesions. Conjunctival hyperaemia， conjunctival exudation and eyelid lesion were noted in 13 patients， 12 patients and 9 patients， respectively. Conjunctival pseudomembrane， lid margin lesion， and corneal erosion were noted in 7 patients， 7 patients and 3 patients， respectively. Systemic corticosteriod was administered in all cases. Ophthalmic treatments were also used on patients with ocular involvement， including corticosteriod eyedrops， cyclosporin eyedrops， artificial tears or separation of symblepharon. Treatment was based on the severity of the ocular symptoms. ConclusionSJS and TEN exhibit variable degrees of skin and mucous membrane damage within the acute stage， commonly accompanied with ocular involvement. Sufficient systemic and local corticosteriod are essential to control disease progression and reduce ocular complications.