碘对比剂静脉注射致皮肤不良反应的危险因素分析

Analysis of Risk Factors of Skin Adverse Reactions by Intravenous Injection of Iodine Contrast Agent

目的:探讨碘对比剂静脉注射导致皮肤不良反应(ADR)的主要危险因素。方法:选取我院2009年1月至2020年4月使用碘对比剂行CT增强后发生皮肤ADR的患者,通过医院信息系统(HIS)收集其基本信息、应用碘对比剂前实验室检查结果及ADR相关信息。统计分析碘对比剂的使用情况、皮肤ADR的主要表现以及临床联合用药情况。以患者性别、年龄、体质量指数(BMI)、碘对比剂用量、住院时间、实验室检查、肿瘤病史、基础病史、过敏史、饮酒史等为自变量,将其分别与碘对比剂相关皮肤ADR发生情况进行单因素分析,选取有统计学意义变量进行多因素Logistic逐步回归分析。结果:发生皮肤ADR者共157例,男性79例(50.3%)、女性78例(49.7%);年龄19~86岁,平均(52.68±18.73)岁;BMI(14.6~40.7)kg/m^2,平均(22.5±3.7)kg/m^2;使用碘普罗胺67例(42.68%)、碘克沙醇34例(21.66%)、碘海醇31例(19.74%)、碘帕醇25例(15.92%);碘对比剂用量50~100 mL,平均(73.06±13.29)mL,4种碘对比剂间用量差异无统计学意义(P>0.05)。4种碘对比剂中,碘普罗胺相关皮肤ADR的发生率最高(0.197%)。碘对比剂相关皮肤ADR以急性(89.2%)为主,严重程度以轻度(75.2%)为主,以荨麻疹(38.9%)最常见,予以对症治疗后痊愈135例、好转13例、未好转9例。发生碘对比剂相关皮肤ADR的患者中,以合并使用抗感染药物的发生率最高(33.1%);但导致重度皮肤ADR则以合并使用抗肿瘤药物为主。住院时间{11~20 d[OR=1.21,95%CI(1.07,1.20),P=0.042]、21~30 d[OR=1.39,95%CI(1.12,1.52),P=0.035]、31~40 d[OR=1.15,95%CI(1.03,1.37),P=0.008]、>40 d[OR=1.33,95%CI(1.28,1.53),P=0.003]}、呼吸循环系统肿瘤病史[OR=1.51,95%CI(1.35,1.61),P=0.037]、注射用药过敏史[OR=1.50,95%CI(1.37,1.59),P=0.005]均可显著增加碘对比剂相关皮肤ADR的发生率。结论:碘对比剂相关皮肤ADR主要表现为荨麻疹,患者的住院时间(≥10 d)、呼吸循环系统肿瘤病史、注射用药过敏史可能是碘对比剂致相关皮肤ADR的主要危险因素。

OBJECTIVE:To investigate main risk factors for adverse drug reactions(ADR)of skin by intravenous injection of iodine contrast agent.METHODS:From Jan.2009 to Apr.2020,the patients suffering from skin ADR after enhanced CT with iodine contrast agent were collected from our hospital.The basic information,laboratory test results before using iodine contrast agent and ADR related information were collected through hospital information system(HIS).The use of iodine contrast agent,main manifestations of skin ADR and drug combination were analyzed statistically.Taking the sex,age,body mass index(BMI),the dosage of iodine contrast agent,length of stay,laboratory examination,tumor history,basic disease,allergy history,drinking history as independent variables,the incidence of skin ADR related to iodine contrast agent was analyzed by single factor analysis,and the variables with statistically significant were selected for multivariate Logistic stepwise regression analysis.RESULTS:There were 157 cases of skin ADR,involving 79 males(50.3%)and 78 females(49.7%).The age ranged from 19 to 86 years old,being(52.68±18.73)years old in average.BMI was 14.6-40.7 kg/m^2,being(22.5±3.7)kg/m^2.67 cases(42.68%)were treated with iprodione,34 cases(21.66%)with iodixanol,31 cases(19.74%)with iohexol and 25 cases(15.92%)with iopamidol;the dose of iodine contrast agent were 50-100 mL,being(73.06±13.29)mL in average.There was no significant difference among different dosage of 4 kinds of iodine contrast agents(P≤0.05).Among 4 kinds of iodine contrast agents,the incidence of skin ADR induced by iopromide was the highest(0.197%).The skin ADR related to iodine contrast agent was mainly acute(89.2%),the severity was mild(75.2%),and urticaria(38.9%)was the most common.After symptomatic treatment,135 cases were cured,13 cases were improved and 9 cases were not improved.Among the patients with iodine contrast agent related skin ADR,the incidence of ADR induced by combined use of anti infective drugs was the highest(33.1%);however,the combined use of anti-tumor drugs was the main cause of severe skin ADR.The length of stay{11~20 d[OR=1.21,95%CI(1.07,1.20),P=0.042]、21~30 d[OR=1.39,95%CI(1.12,1.52),P=0.035]、31~40 d[OR=1.15,95%CI(1.03,1.37),P=0.008]、>40 d[OR=1.33,95%CI(1.28,1.53),P=0.003]},respitatory and circulatory system tumor history[OR=1.51,95%CI(1.35,1.61),P=0.037],injection allergy history[OR=1.50,95%CI(1.37,1.59),P=0.005]can significantly increase the incidence of iodine contrast agent related skin ADR.CONCLUSIONS:The main manifestation of skin ADR related to iodine contrast agent was urticaria.The main risk factors of skin ADR related to iodine contrast agent were length of stay(>10 d),respiratory and circulatory system tumor history and injection allergy history.