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目的分析转归为临床治愈的职业性三氯乙烯药疹样皮炎(OMDT)患者的糖皮质激素(以下简称“激素”)使用方法,为规范该疾病治疗的激素使用方法提供参考。方法采用回顾性调查方法,收集分析2001—2013年经广东省职业病防治院治愈的144例OMDT患者的一般情况、临床资料及激素使用情况。结果 (1)激素使用情况。甲泼尼龙琥珀酸钠首次剂量中位数及第0~100百分位数[M(P_0~P_(100))]为100.0(40.0~1 000.0)mg/d;58例(占40.3%)患者采用首次剂量治疗效果欠佳,在入院后1周内需要上调激素使用剂量,初始剂量M(P_0~P_(100))为120.0(40.0~1 000.0)mg/d;初始剂量维持时间M(P_0~P_(100))为5.5(1.0~14.0)d;治疗有效后应先将激素逐渐减量至停用,当激素使用剂量>100 mg/d时,每隔1~3 d剂量减量20~50 mg,当激素使用剂量<100 mg/d时,每隔2~3 d剂量减量10 mg;激素使用总时间M(P_0~P_(100))为66.0(22.0~229.0)d;激素使用总量M(P_0~P_(100))为3 510.0(420.0~27 336.3)mg。(2)多形红斑组患者激素首次剂量分别低于剥脱性皮炎和大疱性表皮坏死松解症组患者(P<0.05),初始剂量和激素使用总量均小于其他3种皮疹类型患者(P<0.05)。(3)与肝功能轻度损害组比较,肝功能重度损害组患者激素首次剂量、初始剂量和激素使用总量均增加(P<0.05),激素使用总时间延长(P<0.05)。(4)OMDT患者激素首次剂量、初始剂量与激素使用总量均呈正相关[Spearmen相关系数(r_S)分别为0.73、0.78,P<0.01];激素初始剂量维持时间与患者脱离接触三氯乙烯时间及入院时尿三氯乙酸水平均不相关(r_S分别为-0.14、0.10,P>0.05)。(5)二分类Logistic回归分析结果显示,皮疹类型为非多形红斑者、肝功能损害程度越严重者、WBC计数>9.5×10~9/L者,激素首次剂量均应使用>120 mg/d剂量(P<0.05)。结论皮疹类型和肝功能是影响OMDT患者激素使用的重要因素,OMDT激素治疗方案应综合参考两者情况而制定。
Objective outcome glucocorticoid analysis of clinical cure trichlorethylene occupational dermatitis (OMDT) patients (hereinafter referred to as “hormone ”) using the method, to provide reference for the use of hormone therapy regulate the disease. Methods A retrospective survey was conducted to collect and analyze the general situation, clinical data and hormone utilization of 144 patients with OMDT cured by Guangdong Occupational Disease Prevention and Treatment Hospital from 2001 to 2013. Results (1) hormone use. The median and the 0-100th percentile of methylprednisolone sodium succinate were 100.0 (40.0-1 000.0) mg / d and 40.0% (40.3% patients with poor therapeutic effects of the first dose, within 1 week after admission steroid dose necessary to deviate upward, the initial dose M (P_0 ~ P_ (100)) of 120.0 (40.0 ~ 1 000.0) mg / d; initial dose duration M ( P_0 ~ P_ (100)) was 5.5 (1.0 ~ 14.0) d. After the treatment was effective, the hormone should be gradually reduced to disable. When the dose of hormone was> 100 mg / d, the dosage was reduced every 1-3 days 20 ~ 50 mg, when the hormone dosage was less than 100 mg / d, the dosage was reduced by 10 mg every 2 ~ 3 d; the total hormone use time was 66.0 (22.0 ~ 229.0) d; The total amount of hormone used M (P_0 ~ P_ (100)) was 3 510.0 (420.0 ~ 27 336.3) mg. (2) hormones in patients with erythema multiforme groups were lower than the first dose exfoliative dermatitis and bullous epidermal necrolysis patients (P <0.05), and the total amount of the initial dose steroid use are less than the other three types of patients rash ( P <0.05). (3) The first dose, initial dose and total amount of hormones used in patients with severe liver dysfunction increased (P <0.05) and the total time of hormone use increased (P <0.05). (4) OMDT hormones in patients with first dose, the total amount of the initial dose steroid use was a positive correlation [Spearmen correlation coefficient (R_S) respectively 0.73,0.78, P <0.01]; the initial dose of hormone is maintained out of contact with the patient time to time trichlorethylene And urinary trichloroacetic acid levels were not related to admission (r_S-0.14,0.10, respectively, P> 0.05). (5) The results of Logistic regression analysis showed that those patients with non-pleural erythema rash type had the worse liver function damage, WBC count> 9.5 × 10-9 / L, the first dose of hormones should be> 120 mg / d dose (P <0.05). Conclusion The type of rash and liver function are important factors that affect the use of hormones in patients with OMDT. The OMDT hormone therapy regimen should be formulated with reference to both.