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題名 | Clinical Observations og Erythema Multiforme in Children=兒童多形性紅斑之臨床觀察 |
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作者 | 楊曜旭; 蔡銘哲; 曹永魁; 王玲華; 林于粲; 劉淳菁; 羅錦通; 江伯倫; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 40:2 民88.03-04 |
頁次 | 頁107-111+139 |
分類號 | 417.5643 |
關鍵詞 | 多型性紅斑; 兒童; 全身性行固醇; Erythema multiforme; Children; Systemic steroid; |
語文 | 英文(English) |
中文摘要 | 多形性紅斑是一種好發於年輕人的皮膚及黏膜疾病。為了探討此疾病在兒童的臨床表現, 誘發因子及治療結果,自過去十年來(1988年1月至1998年8月)我們收集了三十個罹患此疾病 之兒童,年齡從一個月大到十五歲。其中二十三位屬於輕微型,七位屬於嚴重型(Stevens-Johnson 症候群)。有四位輕微型病童證實被黴漿菌感染,另一位輕微型病童患有腺病毒感染,而一位嚴重型 病童有巨細胞病毒感染。五位嚴重型及二位輕微型病童在發病前曾有服用抗抽筋藥物的病史。所有 的病童於住院後皆接受支持性治療。此外,六位嚴重型及十一位輕微型病童(A組)尚接受口服或 注射類固醇的治療(劑量:prednisolone 1-2 mg/kg/day,療程:3-14天),另外一位嚴重型及十一位 輕微型病痛(B組)則只接受支持性療法。有一位輕微型病童因合併不明性血小板低下紫斑症而接 受了免疫球蛋白的注射。經過治療後,輕微型的平均病程為11.8±2.9天,嚴重型的平均病程為25.1±9.8 天,沒有死亡病例及後遺症的發生。比較AB兩組的平均病程及住院天數(11.4±3.1天 vs 12.4±2.9天, p=0.45) (5.4±2.0天vs 6.3±3.1天,p=0.47),我們發現並無統計學上的差異。此研究顯示:1)感染, 特別是黴漿菌的感染,及抗抽筋藥物在兒童的多形性紅斑扮演相當重要的角色。2)多形性紅斑輕微 型會在二星期內痊癒,而嚴重型會在六星期內痊癒。3)全身性類固醇的給予或許有益於嚴重型,但 是對於輕微型的治療似乎助益不大。 |
英文摘要 | Erythema multiforme (EM), a cutaneous or mucocutaneous disorder, occurs primarily in young adults. To evaluate the precipltating factors, clinical courses, and treatment of this disease in children, 80 cases aged from 1 month old to 15 years of age were studied retrospectively from Jan 1988 to Aug 1998. Twenty-three cases were diagnosed as minor type: the other 7 were of major type (Stevens Johnson syndrome). Mycoplasma infection was identified in 4 patients, and adenovirus in one patient with EM minor. Cytomegalovirus was found in one EM major patient. Anticonvulsant administration befor the skin lesioins were recorded in 5 EM major patients and 2 EM minor patients. All cases received supportive treatment during admission. Besides, 6 of 7 patients with EM major, and 11 of 23 EM minor (Group A) received systemic corticosterold at a dose equal to prednisolone 1-2 mg/kg/day for 8-14 days. One EM major patient all 11 patients with EM minor (Group B) received supportive care only. One EM minor patient with acute idiopathic thrombocytopenia purpura was treated with intravenous mmunoglobulin. The mean duration of course of EM minor was 11.8±2.9 days, and it was 25.1±9.8 days for EM major. No mortality and no sequelae were noted. The average disease course and hospitalization time were not significantly different between Group A and B: (11.4±3.1 days vs 12.4±2.9 days.p=0.45); (5.4±2.0 days vs 6.3±3.1 days, p=0.47). This study demonstrated that infections, especially nycoplasma, and anticonvulsants play important roles in childhood EM. The skin lestions of EM minor ubsided within 2 weeks, and EM major recovered completely within 6 weeks. Systemic corticosteroid may be beneficial to EM major, but probably is unnecessary for patients with EM minor. |
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