SCORTEN评分对中毒性表皮坏死松解症和Stevens-Johnson综合征评估分析

王昱璐; 左亚刚; 刘洁; 刘跃华; 李丽; 孙秋宁; 晋红中

doi:10.3760/cma.j.issn.0412-4030.2016.09.011

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中华皮肤科杂志

• 研究报道 •

ENGLISH ABSTRACT

SCORTEN评分对中毒性表皮坏死松解症和Stevens-Johnson综合征评估分析

作者及单位信息

出版日期： 2016 -09 -15 ·

DOI： 10.3760/cma.j.issn.0412-4030.2016.09.011

Prognostic accuracy of the SCORTEN scoring system in patients with toxic epidermal necrolysis or Stevens-Johnson syndrome

Authors Info & Affiliations

Wang Yulu

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Zuo Yagang

Liu Jie

Liu Yuehua

Li Li

Sun Qiuning

Jin Hongzhong

Published： 2016 -09 -15 ·

DOI： 10.3760/cma.j.issn.0412-4030.2016.09.011

APP内阅读

摘要

目的分析SCORTEN评分对中毒性表皮坏死松解症和Stevens-Johnson综合征患者预后评估的准确性。

方法回顾性分析1992年4月至2014年3月期间在北京协和医院收治的中毒性表皮坏死松解症和Stevens-Johnson综合征39例，其中死亡病例13例，按照年龄分层1∶2匹配诊断明确好转出院26例。39例患者用SCORTEN评分系统评分，计算预期死亡数，比较39例各级分层的预期死亡数与实际死亡数，绘制受试者工作特征曲线（ROC曲线），评估SCORTEN评分的判断力。

结果39例患者中，按SCORTEN评分系统评为1分15例，2分14例，3分6例，4分4例，总预期死亡6.808例，实际死亡13例。每个积分层预期死亡数与实际死亡数差异无统计学意义。SCORTEN评分系统的ROC曲线下面积= 0.832 8，表明有较好的预测能力。

结论SCORTEN评分系统可在早期对中毒性表皮坏死松解症和Stevens-Johnson综合征患者死亡率作出评估。

关键词：表皮坏死松解症，中毒性;药疹;Stevens-Johnson综合征;SCORTEN评分

ABSTRACT

ObjectiveTo evaluate the prognostic accuracy of the score of toxic epidermal necrolysis (SCORTEN) scoring system in patients with toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS) .

MethodsClinical data were collected from 39 patients with SJS/TEN hospitalized in Peking Union Medical College Hospital during April 1992 and March 2014, and retrospectively analyzed. Among the 39 patients, 13 had died, and the other 26 patients, who were matched to the dead patients in a ratio of 2∶1 for age, all had a definite diagnosis and were discharged with improved conditions. The SCORTEN scoring system was used to evaluate the 39 patients with SJS/TEN and calculate expected mortality. The expected mortality and actual mortality were compared between different groups stratified by age in the 39 patients. The receiver operating characteristic (ROC) curve was drawn to assess the prognostic accuracy of the SCORTEN scoring system.

ResultsAccording to the SCORTEN scoring system, 15 out of the 39 patients scored 1 point, 14 scored 2 points, 6 scored 3 points, and 4 scored 4 points. The total number of expected deaths was 6.808, while that of actual deaths was 13. There was no significant difference between the expected mortality and actual mortality in every SCORTEN score-based group. The area under curve (AUC) was 0.832 8, indicating a good predictive ability of the SCORTEN scoring system.

ConclusionThe SCORTEN scoring system can predict mortality in TEN/SJS patients at early stage.

KEYWORDS： Epidermal necrolysis, toxic;Drug eruptions;Stevens-Johnson syndrome;SCORTEN

Corresponding author: Zuo Yagang, Email: tendef.3ab62gnagayouz

FUNDING:

National Natural Science Foundation of China (81071301) ; Beijing Municipal Natural Science Foundation (7132203)

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All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

王昱璐,左亚刚,刘洁,等. SCORTEN评分对中毒性表皮坏死松解症和Stevens-Johnson综合征评估分析[J]. 中华皮肤科杂志,2016,49(9)：651-653.

DOI:10.3760/cma.j.issn.0412-4030.2016.09.011

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*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

Stevens-Johnson综合征（SJS）和中毒性表皮坏死松解症（toxic epidermal necrolysis，TEN）是一组药物过敏反应，可引起特征性的皮损、严重的黏膜和系统受累。临床表现为红斑、松弛性水疱及表皮松解、Nikolsky征阳性、黏膜也有坏死剥脱。受累皮肤的体表面积（body surface area，BSA）< 10%体表面积为SJS，> 30%为TEN，介于两者之间的为SJS/TEN重叠征。SJS死亡率为5%，SJS/TEN重叠征为10%~15%，TEN为30%~40% ^{[
1
]}。SCORTEN（score of toxic epidermal necrolysis）评分量表是对TEN/SJS严重程度的特异性评分 ^{[
2
]}。通过记录入院24 h内的7个临床指标，预测患者的死亡率。SCORTE评分量表简单易用，适用于所有TEN患者，已被应用于预测TEN和SJS患者的死亡率。但有报道 ^{[
3
]}证实，在某些验证SCORTEN评分的研究中存在方法学错误，亦有研究 ^{[
4
]}认为，SCORTEN评分过高预测了死亡率。还有研究报道证实，该评分量表的准确性可能会受到人口分布概况和研究人群特点的影响 ^{[
1
]}，尚需对其准确性做进一步验证。为探讨此评分表在国内患者应用的准确性，我们回顾性分析了39例TEN/SJS患者的临床资料。

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摘要
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备注信息

通信作者：左亚刚，Email： tendef.3ab62gnagayouz

基金项目：

国家自然科学基金 (81071301) 查看更多基金信息

北京市自然科学基金 (7132203) 查看更多基金信息

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