CAJ | 학술논문

目的观察肿瘤坏死因子拮抗剂在重症三氯乙烯药疹样皮炎治疗中的作用.方法 5例以皮疹、发热、浅表淋巴结肿大和肝、肾损害为主要表现的重症三氯乙烯药疹样皮炎患者,在判断无肿瘤、结核及重症感染后,3例采用肿瘤坏死因子拮抗剂25 mg皮下注射,每周2次,联合糖皮质激素治疗;2例单独使用肿瘤坏死因子拮抗剂治疗.结果肿瘤坏死因子拮抗剂联合糖皮质激素治疗的3例患者体温在1周内降至正常,住院期间未发生感染、急性肝功能衰竭等,出院时皮疹消退,口腔、外阴等黏膜恢复正常,肝肾功能正常,平均住院时间36 d.单独使用肿瘤坏死因子拮抗剂的2例患者均治愈,临床疗效与联合糖皮质激素治疗的患者无明显差别,治疗后28周测得血清肿瘤坏死因子α水平降至正常.结论在重症三氯乙烯药疹样皮炎的治疗过程中尽早、足量使用肿瘤坏死因子拮抗剂有益于快速控制病情.
목적 관찰종류배사인자길항제재중증삼록을희약진양피염치료중적작용.방법 5례이피진、발열、천표림파결종대화간、신손해위주요표현적중증삼록을희약진양피염환자,재판단무종류、결핵급중증감염후,3례채용종류배사인자길항제25 mg피하주사,매주2차,연합당피질격소치료;2례단독사용종류배사인자길항제치료.결과 종류배사인자길항제연합당피질격소치료적3례환자체온재1주내강지정상,주원기간미발생감염、급성간공능쇠갈등,출원시피진소퇴,구강、외음등점막회복정상,간신공능정상,평균주원시간36 d.단독사용종류배사인자길항제적2례환자균치유,림상료효여연합당피질격소치료적환자무명현차별,치료후28주측득혈청종류배사인자α수평강지정상.결론 재중증삼록을희약진양피염적치료과정중진조、족량사용종류배사인자길항제유익우쾌속공제병정.
Objective To estimate the effect of a tumor necrosis factor antagonist in the treatment of medicamentosa-like dermatitis induced by trichloroethylene.Methods Five patients,who presented with skin eruptions,fever,superficial lymphadenectasis,hepatic and renal damage,were diagnosed with severe medicamentosa-like dermatitis induced by trichloroethylene.Of them,three patients,who had been confirmed not to have tumor,tuberculosis or severe infection,were treated with a recombinant human tumor necrosis factor antagonist (25 mg,subcutaneous injection,twice per week) combined with glucocorticoid,and the other two patients were treated with the tumor necrosis factor antagonist alone.Results In the three patients treated with the tumor necrosis factor antagonist combined with glucocorticoid,body temperature dropped into the normal range within a week.No infection or acute hepatic failure was observed during their hospitalizations.When they were discharged from hospital,the skin rashes subsided,oral and vulval mucosae were recovered,and hepatic and renal function was restored,with the median hospital stay being 36 days.The other two patients treated with the tumor necrosis factor antagonist alone were also cured,and the serum level of tumor necrosis factor-α returned to normal on week 28 after initiation of treatment.There was no significant difference in clinical efficacy between the combination therapy and monotherapy.Conclusion To use a tumor necrosis factor antagonist at an adequate dose as early as possible is beneficial to the treatment of severe medicamentosa-like dermatitis induced by trichloroethylene.