| ObjectiveTo retrospectively analyze the clinical application of intravenous immunoglobulin combined with glucocorticoid in treatment of Stevens-Johnson syndrome and Toxic epidermal necrolysis.The efficacy of combination treatments analyzed and we also try to evaluate the effective rate of the disease,and provide the choice for clinical treatment..Methods92 cases of clinical data were collected in Qilu Hospital of Shandong University from January 2003 to December 2017,On the basis of their clinical features and medical history,the clinical diagnosis are in accordance with Stevens-Johnson syndrome and toxic epidermal necrolysis.The patients are divided into SJS group and TEN group.Within 24 hours after admission,we calculate the SCORTEN and offending drugs.According to their treatment therapy after admission,every group was divided into two groups:GC group and GC + IVIG group.Based on the days of onset of eruption,less than five days was divided into I group,or else Ⅱ group.The collected data were analyzed between the two groups and within the group respectively.The hospitalization days,the days of the control of skin lesions and the maximum doses of steroids(prednison equivalent),the time of tapering steroids were used to evaluate the difference between the groups.And we also assess the effective rate of each group.Enumeration data was using chi-square test,measurement data was using t-test.Result92 patients were divided into GC group and GC+IVIG group,42patients were diagnosed with SJS which was divided into two groups(GC group and GC+IVIG group),others were TEN which was divided into two groups(GC group and GC+IVIG group).To analyse the hospitalization days,the days of the control of skin lesions,the maximum dose of steroids(prednison equivalent)and the primary time of administrating IVIG therapy.There was no difference between these groups in age,gender and SCORTEN.1.Hospitalization daysIn SJS group,the average length of hospitalized stay in GC group was 11.19 ±3.52 days compared with that in GC + IVIG group was 12.63 ±3.93days,there was no significant difference between the two groups(P = 0.246).In TEN group,the GC group was 13.83 ±4.70 days,and the GC + IVIG group was 16.00± 5.42 days.There was no significant difference between the two groups(P = 0.233).2.The days of the control of skin lesionsIn SJS group,The average control time of skin lesion was 6.25+ 1.98 days in GC group and 4.42 ± 2.10days in GC+IVIG group(P=0.009).In TEN group,the average skin lesion control time was 7.92 ± 2.81 days in GC group and 5.50 ±2.14days in GC + IVIG group.There was significant difference between the two groups(P=0.004).3.The time of reducing the steroidsIn SJS group,the average time of reducing steroids in GC group was 8.06 ±2.69days,that in GC+IVIG group was 5.88 +2.83days,there was significant difference between two groups(P=0.02).In GC group of TEN was 8.83 ±3.32days,and 8.56 ±2.34 days was in GC+IVIG group,no difference between two groups(P=0.766).In SJS group,combination therapy could reduce the time of the steroids reduction.4.The maximum dose of steroids(prednison equivalent)The average amounts of prednisone in GC group of SJS was 1.59 ±0.42 mg/kg/d,and the average dose of GC + IVIG group of SJS was 1.93 ± 0.86mg/kg/d,with no significant difference between the two groups(P = 0.105).That in GC group of TEN was 2.09 ± 0.54mg/kg/d,and in GC + IVIG group of TEN was2.68 ± 0.72mg/kg/d(P=0.015).5.Offending drugsIn SJS group of all clinical data,the highest proportion was carbamazepine(23.80%)followed by antibiotics(14.29%),lamotrigine(9.52%)and ibuprofen(7.14%),antipyretic analgesic(2.38%),allopurinol(2.38%,HLA-B＊5801was positive),cold medicine(4.76%)and phenytoin(2.38%).In TEN group,carbamazepine(18.00%),followed by antibiotics(16.00%),lamotrigine(4.00%),ibuprofen(2.00%),antipyretic analgesic(6.00%),phenytoin(4.00%),cold medicine(4.00%),traditional Chinese medicine(4.00%)and allopurinol(2.00%).In these two groups,uncertained drugs or many drugs together before the onset of the disease was(30.95%,28.00%).6.The effective rate of SJS and TENIn SJS group,the effective rate was 96%in the combination group in comparison to 94%in the controls,there was no significant difference between two groups(P=0.779).In TEN group,the effective rate of combination therapy with steroids and IVIG was88%,the monotherapy group was 75%,no difference between two groups(P=0.234).7,The primary time of using IVIG therapyThe average days of the control of skin lesion in I group was 3.94 ±1.55days,that in II group was 5.56 ± 2.26days.There was significant difference between them(P=0.004).Average hospitalization of I group was 12.78 ± 4.78days and in Ⅱ group was 15.36 ± 5.04days,with no significant difference between two groups(P=0.077).The time of reducing steroids of I group was 6.39 ± 2.93days,and in Ⅱ group was 7.64 ± 2.88days,with no significant difference(P=0.141).The earlier of using IVIG,the shorter the control of skin lesions.Conclusion1.Combination therapy with corticosteroid and IVIG exhibited a tendency to reduce the time of control skin lesion and the time of reducing steroids in SJS group.2.Combination treatment could reduce the time of control skin lesion in TEN group,but not reduce the time of tampering steroids.3.Combination regimen could not reduce hospital length of stay and the maximum dose of steroids of SJS and TEN.4.Early administration of IVIG within the first 5 days after the onset of eruption was essential for its therapeutic efficacy.It would arrest progression earlier and decrease the hospitalization time. |
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