糖皮质激素联合静脉滴注用人免疫球蛋白治疗儿童中毒性表皮坏死松解症3例并文献复习

发布时间：2018-05-02 03:17

本文选题：儿童 + 药疹　；参考：《大连医科大学》2013年硕士论文

【摘要】：背景：TEN（Toxic epidermal necrolysis，中毒性表皮坏死松解症）又称大疱性表皮松解萎缩型药疹（drug-induced bullosa epidermolysis）是一种罕见的、爆发性出现广泛的皮肤粘膜和内脏损害的严重性皮肤病。TEN预后较差，统计表明死亡率高达25~35%。多由服药或上呼吸道感染而诱发，而对于儿童除了药物致敏诱发外，也常由感染因素诱发，如肺炎支原体或单纯疱疹病毒，还有骨髓移植或器官移植。TEN为皮肤科的重症之一，若发生于儿童风险更大。本病发病机制尚不清楚，治疗上存在争议。病例报告：我科于2011年7月29日至9月15日间，应用糖皮质激素联合免疫球蛋白成功治愈三名TEN男性患儿。TEN进展快，三名患儿均在入院后的2天内出现严重的表皮剥脱，累及面积超过体表面积的30%，并且均累及眼结膜、口腔黏膜及会阴部黏膜。在3例TEN患儿发病早期，给予甲基强的松龙2~3mg/(kg·d)静脉滴注，同时予静脉注射人免疫球蛋白(Intravenous immunoglobulin，IVIG)0.4g/(kg·d)连续治疗5天。同时给予积极有效的支持治疗和全面的护理。经治疗3例患者皮肤及黏膜损害得到有效控制。3名患儿于出院时，糖皮质激素均减量至停药。治疗过程中未见明显不良反应。结论：对于儿童TEN，糖皮质激素联合免疫球蛋白治疗是该病目前比较理想的治疗方案。免疫球蛋白对于治疗TEN的作用是肯定的。与成人相比较，无论免疫球蛋白应用剂量大小，，都能够明显改善儿童TEN的病情。联合应用能够更及时的控制患者病情的进展，缩短了住院时间，并且有助于糖皮质激素的快速减量，减少了其带来的副作用，降低了该病的死亡率。
[Abstract]:Background: Toxic epidermal necrosis (toxic epidermal necrolysis), also known as epidermolysis bullosa atrophy type (drug-induced bullosa epidermis molysis), is a rare disease with a poor prognosis of severe dermatosis with extensive skin, mucosal and visceral lesions. Statistics show that the death rate is as high as 25% 35%. Most of them are induced by medication or upper respiratory tract infection, and in addition to drug sensitization, children are also often induced by infection factors, such as Mycoplasma pneumoniae or herpes simplex virus, and bone marrow transplantation or organ transplantation. TEN is one of the severe cases in dermatology. Children are at greater risk if they occur. The pathogenesis of the disease is not clear, and treatment is controversial. Case report: from July 29 to September 15, 2011, our department successfully cured three male TEN patients with TEN by using glucocorticoid combined with immunoglobulin. All of them developed severe epidermal exfoliation within 2 days after admission. The area involved was more than 30% of the body surface area, and the conjunctiva, oral mucosa and perineum mucosa were all involved. At the early stage of onset of TEN, patients with TEN were given intravenously infusion of methylprednisolone (2~3mg/(kg d) and intravenous injection of human immunoglobulin (IVIG) 0.4 g / kg / d for 5 days. At the same time, to actively and effectively support treatment and comprehensive care. Skin and mucous membrane lesions were effectively controlled in 3 patients after treatment, glucocorticoids were reduced to withdrawal after discharge. There was no obvious adverse reaction during the treatment. Conclusion: glucocorticoid combined with immunoglobulin is an ideal treatment for TEN in children. The role of immunoglobulin in the treatment of TEN is positive. No matter the dose of immunoglobulin, it can improve the condition of TEN in children. Combined use can control the progress of patients more timely, shorten the hospitalization time, and help to reduce the rapid reduction of glucocorticoid, reduce its side effects, reduce the mortality of the disease.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R758.2

【参考文献】