皮内试验对头孢曲松钠过敏反应预测价值的回顾性研究

Predictive value of intradermal test on anaphylaxis induced by ceftriaxone sodium: a retrospective study

目的回顾性探讨皮内试验(皮试)对头孢曲松钠过敏反应的预测价值。方法采用随机等距抽样法,抽取2013年11月至2015年6月在福建医科大学附属泉州第一医院使用头孢曲松钠前进行皮试患者的病历资料进行回顾性分析。根据皮试结果,将患者分为皮试阳性组与皮试阴性组,分析皮试阳性组患者的用药情况,分析皮试阴性组使用头孢曲松钠后出现过敏反应患者的年龄、过敏反应发生时间、临床表现和转归。根据Poisson分布原理,计算皮试阴性组使用头孢曲松钠后过敏反应发生率与假设的不进行皮试使用头孢曲松钠出现过敏反应发生率间的差异。结果纳入分析的患者共943例,皮试阳性组30例(3.18%),皮试阴性组913例(96.82%)。皮试阳性组患者均未再进行阳性与阴性对照试验及激发试验,在此后治疗中分别使用头孢哌酮钠舒巴坦钠、头孢唑肟、阿奇霉素、左氧氟沙星、阿莫西林舒巴坦、替考拉宁和莫西沙星,均未发生过敏反应。皮试阴性组913例患者在使用头孢曲松钠过程中有10例(1.10%)出现过敏反应,过敏反应发生率为1.10%。发生过敏反应的10例患者中男性、女性各5例,年龄10个月~52岁,≤10岁者6例;4例过敏反应发生在用药后20min内,6例在用药后4~10d。主要症状为皮疹和瘙痒,停药及对症处理后好转。皮试阴性组头孢曲松钠过敏反应发生率(1.10%)与假设的应用头孢曲松钠前不进行皮试过敏反应发生率(1%)间的差异无统计学意义(u=0.288,P=0.77)。结论使用头孢曲松钠前进行常规皮试阴性者未显著降低过敏反应的发生率,提示皮试对头孢曲松钠过敏反应无明显的预测价值。

ObjectiveTo explore the predictive value of intradermal test on anaphylaxis induced by ceftriaxone sodium retrospectively.MethodsMedical records of patients who underwent intradermal test before ceftriaxone sodium treatment in the First Hospital of Quanzhou Affiliated to Fujian Medical University from November 2013 to June 2015 were collected with random equidistant sampling and analyzed retrospectively.The patients were divided into the positive intradermal test group and the negative intradermal test group according to the results of intradermal test.The situation of medication in patients in the positive intradermal test group and the ages,onset time of anaphylaxis,clinical manifestations,and outcomes in patients with allergic reactions after ceftriaxone sodium treatment in the negative intradermal test group were analyzed,respectively.The difference between the incidence of anaphylactic reactions after ceftriaxone sodium treatment in the negative intradermal test group and the hypothetical incidence of anaphylactic reactions after ceftriaxone sodium treatment without intradermal test were calculated according to Poisson distribution principle.ResultsA total of 943 patients were enrolled in the study,including 30 patients(3.18%)in the positive intradermal test group and 913 patients(96.82%)in the negative intradermal test group.Neither the positive and negative control tests nor the provocative tests were performed in patients in the positive intradermal test group and no allergic reactions appeared in these patients in the following treatments with cefoperazone sodium and sulbactam sodium,ceftizoxime,azithromycin,levofloxacin,amoxicillin sulbactam,teicoplanin,and moxifloxacin,respectively.Ten(1.1%)of 913 patients in the negative intradermal test group developed anaphylaxis during the use of ceftriaxone sodium,the incidence of anaphylactic reaction was 1.10%,in whom male and female were 5 respectively,aged 10 months to 52 years,6 patients were 10 years old.Of the 10 patients with anaphylactic reactions,4 developed within 20 minutes and 6 developed 4 to 10 days,respectively after the administration.The main symptoms were rash and pruritus,which improved after drug withdrawal and symptomatic treatments.There were no significant difference(u=0.288,P=0.77)between the incidence of anaphylactic reactions in the negative intradermal test group(1.1%)and the hypothetical incidence of ceftriaxone sodium-induced anaphylactic reactions without intradermal test(1.0%).ConclusionThe incidence of anaphylaxis did not decrease significantly in patients with negative intradermal test,suggesting that the intradermal test has no obvious value to predict the occurrence of ceftriaxone sodium-induced anaphylaxis.