Objective To assess the therapeutic effect of severe drug eruption(including erythema multiforme drug eruption,drug?induced bullosaepidermolysis and drug?induced exfoliative dermatitis)with combined different dose intravenous immunoglobulin and glucocorticoid. Methods 32(group 1)and 36(group 2)cases were carried out by mid?dose 0.2 g/(kg · d),high?dose 0.4 g/(kg · d)intravenous immunoglobulin for 5 days respectively,and combined glucorticoid [0.8~1 mg/(kg · d)]. 30(group 3) cases were treated with glucorticoid alone. The dose of glucorticoid hormone was reduced according to improving of disease condition. Obvervational index were defervescence time, deflorescence time, hospitalization days and adverse reaction. Statistic method was analysis of variance. Results Defervescence time,deflorescence time and hospitalization days of mid?dose,high?dose intravenous immunoglobulin and control group were(2.29±2.69)d,(2.16±1.98)d,(3.98±2.71)d(group 1 vs. group 3:Q=3.824,P<0.01;group 2 vs. group 3:Q=3.234,P<0.01;group 1 vs. group 2:Q=0.308,P>0.05);(2.97±2.75)d,(2.46±0.96)d,(4.21±1.28)d (group 1 vs. group 3:Q=3.794,P<0.01;group 2 vs. group 3:Q=3.794,P<0.01;group 1 vs. group 2:Q=3.794,P<0.01);(21.58 ± 11.18) d,(20.16 ± 9.29) d,(26.96 ± 23.26)d(F=1.145,P=0.335),three groups had no statistic difference respectively. There were five cases of IVIg adverse reaction slightly ,including group 1 had one case and group 2 had four cases. Incidence was 7.35%(5/68). Conclusion Our data indicated that combination therapy of corticosteroids and IVIg achieved a better therapeutic effect than the administration of corticosteroids alone. Combination therapy of corticosteroids and mid?dose IVIg was better choice for patients with severe underlying disease.%目的 探讨不同剂量静脉注射免疫球蛋白(IVIg)联合糖皮质激素治疗重症药疹的临床疗效.方法 以不同剂量IVIg[中等剂量0.2 g/(kg·d),大剂量0.4 g/(kg·d),静脉点滴,连续5天为一疗程]联合糖皮质激素[甲基强的松龙0.8~1 mg/(kg·d)]分别治疗32例和36例重症药疹.30例单纯以糖皮质激素治疗.激素的用量根据病情改善情况逐渐减少.疗效观察指标为药物热退热时间、皮疹开始消退时间、住院时间、副作用等.结果 中、大剂量IVIg联合糖皮质激素及单纯糖皮质激素治疗重症药疹的退热时间分别为(2.29±2.69)d、(2.16±1.98)d、(3.98±2.71)d,联合组的退热时间均短于单纯糖皮质激素组(Q值3.824,P<0.01;Q值4.234,P<0.01);两联合组的退热时间无显著差异(Q值0.308,P>0.05).皮疹开始消退时间分别为(2.97±2.75)d、(2.46±0.96)d、(4.21±1.28)d,三组间的皮疹消退时间差异均有统计学意义(Q值均为3.794,P值均<0.01).住院时间分别为(21.58±11.18)d、(20.16±9.29)d、(26.96±23.26)d,住院时间无明显差异(F=1.145,P=0.335).IVIg联合激素治疗的68例患者的副反应发生率仅7.35%(5/68),均为轻微副作用.结论 IVIg联合糖皮质激素治疗重症药疹的疗效优于单纯糖皮质激素治疗,对于合并严重基础疾病的患者,IVIg中等剂量联合糖皮质激素治疗是一个较好的选择方案.
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