非离子型碘造影剂的过敏样反应

Anaphylactoid Reactions to Nonionic Contrast Media

目的:对临床使用的非离子型碘造影剂的过敏样反应进行总结和分析。方法:回顾性总结2004年4月至2006年6月期间,在我院进行冠状动脉(冠脉)造影和(或)介入治疗的患者群中,接受非离子型碘造影剂血管内注射后1小时之内发生的过敏样反应病例,参照美国放射学会的诊断标准,根据患者的临床表现分为轻、中、重度三型;针对性别、年龄、冠脉病变程度、造影剂品种等变量因素进行分析和统计学处理。结果:在17033例患者中计有217例发生过敏样反应(发生率1.28%),轻、中、重度过敏样反应的发生率分别为0.22%、0.80%和0.26%,死亡3例(死亡率0.018%);男性患者的过敏样反应发生率高于女性患者(1.37%vs0.98%,P<0.05),在冠脉病变程度、不同造影剂品种等因素的分析中未检出性别之间存在显著性差异;过敏样反应发生率随年龄增加呈下降的趋势,经多元回归分析呈线性关系,男性患者尤为明显;过敏样反应的发生率与冠脉病变程度无显著相关性;年龄、不同造影剂品种对于过敏样反应的三型构成比无显著影响,在女性患者、冠脉多支病变患者尤其是病变累及左主干的患者人群中发生重度过敏样反应的比例较高。结论:非离子型碘造影剂在临床应用中安全性良好,过敏样反应发生率为1.28%,男性患者的过敏样反应发生率高于女性患者,过敏样反应发生率随患者年龄增加而呈下降趋势,在女性患者、冠脉多支病变尤其是病变累及左主干的患者人群中发生重度过敏样反应的比例较高。

Objective：To assess anaphylactoid reaction of nonionic contrast media used during diagnostic coronary angiography and/or percutaneous coronary intervention. Methods：We retrospectively evaluated the outcomes of 17 033 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention in our hospital from April 2004 to June 2006. Patients with anaphylactoid reactions to nonionic contrast media,which typically occurred within 1 hour after intravascular injection,were analyzed. The symptoms of anaphylactoid reaction were classified as mild, moderate, and severe, according to the diagnostic criteria established by American College of Radiology （2004） . The frequency of anaphylactoid reactions and major adverse cardiac events （MACE） were noted. Results：Two hundred and seventeen of 17 033 patients（ 1.28% ） exhibited anaphylaetoid reaction. The incidences of mild, moderate and severe reactions were 0. 22% ,0. 80% and 0. 26%. Among them,3 patients （0. 018% ） were dead . Statistic data showed that male,younger patients had higher incidence of anaphylactoid reaction. Female patients, with severe coronary artery lesions,especially with left-main coronary artery lesions, had higher frequency in the subgroup of severe reactions. Our results showsd no significant difference in terms of tolerability among varieties of nonionic contrast media and severities of coronary artery lesions. Conclusion：Nonionic contrast media can be used safely during diagnostic coronary angiography and/or percutaneous coronary intervention. The incidence of anaphylaetoid reaction is 1.28%. Male and younger patients have higher incidence of anaphylactoid reaction. Female patients, with severe coronary artery lesions, especially with left-main coronary artery lesions, are more frequently seen in the subgroup of severe reactions.