20806例头孢类药物皮试影响因素的logistic回归分析

A logistic regression analysis of 20 806 cases for influence factors of skin test on cephalosporins

目的:分析头孢菌素(简称头孢)类药物皮肤敏感性实验(简称皮试)的结果和影响因素,为评估头孢类药物皮试结果的临床指导价值提供数据依据。方法:提取某三甲医院2013年8月1日-2015年7月31日所有出院病例中使用注射用头孢唑林、头孢呋辛、头孢曲松、头孢他啶、头孢替安、头孢哌酮舒巴坦并皮试的病例,提取患者的年龄、性别、科室、皮试结果以及所用药物的规格、产地、使用数量等信息。同时统计同时段中进行青霉素皮试患者的性别、年龄和皮试结果作为对照。单变量分析中采用χ~2检验分析计数资料,采用独立样本t检验分析计量资料,两两比较采用Bonferroni校正。在单变量分析中具有统计学意义的变量纳入logistic回归进行多变量分析。结果:共统计进行头孢类药物皮试的病例20 806例,皮试阳性率显著高于青霉素(5.81%vs.2.19%,P<0.001)。在单变量分析中,患者的年龄(P<0.001)、性别(P=0.04)、住院的科室(P<0.001)、药物的种类(P<0.008 3)、产地(P=0.002)显著影响皮试的结果。多因素分析中,男性患者(P=0.003)、内科系统住院(P<0.001)和高龄患者(P<0.001)的皮试阳性率明显下降,且独立于其他因素存在。结论:头孢类药物皮试结果受多种因素的影响,存在着假阳性、假阴性的可能。老年人、男性患者、内科住院是患者皮试阴性的独立危险因素。头孢类药物皮试结果的临床指导价值有待商榷。

OBJECTIVE To analyze the risk factors for skin tests on cephalosporins,assess the reliability and the guidance value of the skin test results.METHODS A retrospective observational study was performed for skin tests on cephalosporins from August 1st,2013 to July 31 st,2015 by using an electronic medical record system in a tertiary care hospital.Ceftriaxone,cefuroxime,cefazolin,cefotiam,ceftazidime,cefperazone-sulbactam were involved.The age,gender,department,skin test result,drug name,production area of drug were reviewed for each patient.The same information of penicillin was collected in the same period.Theχ^2 test was used to compare categorical variables and student＇s t-test was used to compare patient age.Bonferroni correction was conducted for paired comparison.The relationship between risk factors and the results of skin test were analyzed with a logistic regression model.RESULTS Totally 20 806 cases with results of skin tests on cephalosporins were included.The rate of positive response was significantly higher in the cephalosporin group than in the penicillin group（5.81%vs.2.19%,P〈0.001）.In the univariate analysis,negative response was associated with patient age（P〈0.001）,gender（P=0.04）,admitted department（P〈0.001）,drug varieties（P〈0.008 3）and production area of drug（P=0.002）.In the multivariate analysis,age（P〈0.001）,gender（P=0.003）and admitted department（P〈0.001）were identified,which independently affected the results of skin tests on cephalosporins.CONCLUSION The guidance value of routine skin test on cephalosporins may be limited because many confounding factors are present and can influence the results of skin test on cephalosporins.