苄星青霉素皮肤试验现状调查与分析

Investigation and analysis on the current situation of skin test of benzathine benzylpenicillin

目的了解我国皮肤科医师对梅毒患者接受苄星青霉素治疗前进行皮肤试验(皮试)的实施现状。方法自行设计调查问卷,问卷内容包括接受调查者基本信息(问题1)、梅毒患者拟接受苄星青霉素治疗时皮试时间(问题2)、认为目前青霉素皮试存在的问题和建议(问题3)等3个方面。依托中华医学会心身医学分会心身皮肤病协作学组,以网络问卷方式展开调查,国内皮肤科医师自愿参与。调查时间为2021年7月2日至8月16日。对获得的数据进行描述性统计分析。结果共回收电子问卷366份,确认有效的为358份(回收率97.8%)。358位皮肤科医师来自全国20个省、4个直辖市、4个自治区的247个单位,其中三级甲等医院129家;人数居前3位的为北京市(148位,41.3%),云南省(42位,11.7%),河南省(25位,7.0%)。358位医师中,222位(62.0%)选择"每周注射苄星青霉素前均需皮试",102位(28.5%)选择"连续注射者,7 d内再次注射时无需再次皮试",33位(9.2%)选择"连续注射者,72 h内无需再次皮试",1位(0.3%)选择"其他"并补充说明"在停药48 h后需再次皮试"。三级甲等医院有更高比例的医师(32.5%,64/197)选择"连续注射者,7 d内再次注射时无需再次皮试"。91位(25.4%)医师对问题3进行了回答,均认为目前的苄星青霉素皮试现状给临床治疗带来了困惑,部分医师给出了制定苄星青霉素皮试规范、增加对照试验等建议。结论国内对苄星青霉素治疗梅毒的皮试时间窗和操作无统一标准,阻碍了梅毒的规范化治疗,亟需制定苄星青霉素皮试的指导性文件。

Objective To understand the current situation of skin tests before treatment with benzathine benzylpenicillin adviced by doctors of Dermatology Department on syphilis patients in China.Methods A self-designed survey questionnaire was used,which included content of 3 aspects:basic information of the respondents(question 1),the time of the skin test in syphilis patients who were schedule to receive treatment with benzathine benzylpenicillin(question 2),and the issues and suggestions regarding the current skin test method of benzathine benzylpenicillin(question 3).Based on the Collaborative Study Group on Psychodermatology of the Psychosomatic Medicine Branch of the Chinese Medical Association,the survey was conducted through online questionnaires and domestic doctors of Dermatology Department participated voluntarily.The investigation period was from July 2,2021 to August 16,2021.The obtained information was analyzed descriptively.Results A total of 366 electronic questionnaires were collected,of which 358 were confirmed to be valid,with a recovery rate of 97.8%.The 358 doctors of Dermatology Department were from 247 medical institutes in 20 provinces,4 municipalities,and 4 autonomous regions across the country,including 1293A-level first-class hospitals.The top 3 areas in number of respondents were Beijing(148 respondents,41.3%),Yunnan province(42 respondents,11.7%),and Henan province(25 respondents,7%).Among the 358 doctors,222(62.0%)chose"conduct skin test weekly before injection of benzathine benzylpenicillin",102(28.5%)chose"in continuous injection,no further skin test is required for re-injection within 7 days",33(9.2%)chose"in continuous injection,no further skin test is required for re-injection within 72 hours",and 1(0.3%)chose"other"and then added"further skin test is required after 48 hours of discontinuation".Compared with other medical institutions,there was a higher proportion of doctors(32.5%,64/197)chose"in continuous injection,no further skin test is required for re-injection within 7 days"in hospitals of 3A-level first-class.Ninety one doctors(25.4%)answered question 3,all of whom believed that the current status of skin tests of benzathine benzylpenicillin had caused confusion in clinical treatment and some doctors provided suggestions such as developing standards for skin tests of benzathine benzylpenicillin and adding controlled trials.Conclusions The skin test time window and operation have not been standardized in the treatment of syphilis with benzathine benzylpenicillin in China,which hinders the standardized treatment of syphilis.It is urgent to develop guidance documents for the skin test of benzathine benzylpenicillin.