狂犬病免疫球蛋白临床应用及再思考

Clinical application and rethinking of rabies immunoglobulin

目的分析狂犬病暴露风险人群狂犬病免疫球蛋白(rabies immunoglobulin,RIG)的应用情况,探讨RIG的安全性和影响其应用的相关因素。方法通过横断面研究调查2019年4月至11月间在解放军总医院第六医学中心就诊的狂犬病暴露者,分析比较注射RIG和拒绝注射RIG两组暴露者的临床特征差异,并通过逐步多元Logistic回归分析研究影响注射RIG的决定因素。结果1395例Ⅲ级暴露者,其中男性662例,占47%,女性733例,占52.5%,中位年龄29(9~49)岁,注射RIG的有1049例,未注射的有346例。注射RIG时的不良反应包括疼痛(97.6%)、头晕(7.0%)、恶心(6.5%)、胸闷(2.1%)、晕厥(0.3%)。逐步多元Logistic回归分析发现成年人(OR=17.140,95%CI:9.668~30.324)、中老年人(OR=12.921,95%CI:6.835~24.4328)、致伤动物是猫(OR=3.183,95%CI:2.091~4.844)、抓伤(OR=7.664,95%CI:4.271~13.751)、伤情轻微(OR=21.750,95%CI:11.704~40.420)的暴露者更倾向于选择不注射RIG。结论对于狂犬病Ⅲ级暴露人群,规范注射RIG是安全有效的,伤情轻、年龄偏大的非犬致伤的暴露者倾向于不注射RIG。

Objective To analyze the administration of rabies immunoglobulin(RIG)in populations who had rabies virus exposure,and to investigate the safety of RIG and related factors affecting its administration.Methods This cross-sectional study included the rabies virus exposed victims who were treated at the sixth medical center of the People’s Liberation Army(PLA)General Hospital from April to November 2019.The clinical characteristics of the patients who accepted RIG injection and those who refused RIG were analyzed and compared,and the determinant factors of the RIG injection were studied by stepwise multiple logistic regression analysis.Results There were 1395 cases of category III exposure,of whom 662(47%)were males,733(52.5%)were females.The median age was 29(9-49)years.Among them,1049 cases were injected with RIG,while 346 were not injected with RIG.Side effects associated with RIG injection included pain(97.6%),dizziness(7.0%),nausea(6.5%),chest tightness(2.1%),and syncope(0.3%).Stepwise multiple logistic regression analysis showed that adults(OR=17.14,95%CI:9.69-30.32),middle-aged and elderly(OR=12.92,95%CI:6.83-24.43),and those whose injury was caused by cats(OR=3.18,95%CI:2.09-4.84),scratches(OR=7.66,95%CI:4.27-13.75),those with minor injuries(OR=21.75,95%CI:11.70-40.42)more likely to choose not to inject RIG.Conclusions It is safe and effective to inject RIG for patients with grade III exposure to rabies virus.Exposed persons who are not injured by dogs,slightly injured and elderly people tend not to inject RIG.