[Staging of occupational medicamentosa-like dermatitis due to trichloroethylene]

Objective: To explor staging of the general course of occupational medicamentosa-like dermatitis due to trichloroethylene (OMDT) to better understand the characteristics of OMDT course, and to provide reference for clinical diagnosis and treatment and related studies. Methods: We collected main clinical manifestation and auxiliary examination data during hospitalization to May 2019 from 35 OMDT patients with complete course record who were hospitalized from January 2014 to December 2018. Continuous monitoring indicators with changing trends including main clinical manifestation indicators, peripheral white blood cell counts, liver function indicators such as serum alanine aminotransferase activity, myocardial enzyme indicators such as serum lactate dehydrogenase activity were selected and used with their standardized values to do cluster analysis on time point (week as unit) of the course of each patient. The clustering results combined with changing trends of the indicators were used to determine the stages of course of each patient, and therefore the staging of general course of OMDT was calculated. Positive rates or average levels of the indicators were compared between different stages, and the correlation of duration of each stage was analyzed with physical characteristics, disease characteristics and treatment measures of the patients. Results: General course of OMDT could be divided into acute phase (3.0±1.5) weeks and chronic phase (11.0±4.4) weeks, while chronic phase could be further divided into early period (5.0±3.0) weeks and later period (6.5±3.7) weeks. Compared with chronic phase, clinical manifestation indicators, white blood cell counts (except eosinophil count) , liver function indicators (except total protein and albumin concentration) , and myocardial enzyme indicators were all increased (all P<0.01) , while total protein and albumin concentration decreased (P<0.05 and P<0.01, respectively) in acute phase. Compared with later period of the chronic phase, clinical manifestation indicators (except fever) , white blood cell counts (except lymphocyte count) , liver function indicators (except total protein and albumin concentration) , and creatine kinase isoenzyme activity were all increased (all P<0.01) , while total protein, albumin concentration and creatine kinase activity decreased (all P<0.01) . Duration of acute phase were positively correlated with the time before glucocorticoid treatment (r(spearman)=0.62, P(adjust)<0.01) , and early and later periods of chronic phase were both positively correlated with corresponding duration of glucocorticoid treatment (r(spearman)=0.96, P(adjust)<0.01, r(spearman)=0.91, P(adjust)<0.01, respectively) . Conclusion: For the first time, the study objectively determined stages of general course of OMDT based on combination of multiple indicators, and analyzed characteristics of main indicators in each phase and potential factors related to the duration of each phase.