马血清破伤风抗毒素与马破伤风免疫球蛋白F(ab′)2引起的皮肤迟发型变态反应临床分析  

Clinical analysis of cutaneous delayed-type hypersensitivity caused by injection of equine tetanus antitoxin or equine anti-tetanus immunoglobulin F(ab′)2

作　　者：康莉 刘艳 郑云燕[2] 鞠梅 张亚美 毕志刚 芦桂青 Kang Li;Liu Yan;Zheng Yunyan;Ju Mei;Zhang Yamei;Bi Zhigang;Lu Guiqing(Department of Dermatology,Nanjing BenQ Medical Center,The Affiliated BenQ Hospital of Nanjing Medical University,Nanjing 210019,China;Department of Dermatology,The Third Affiliated Hospital of Soochow University,The First People′s Hospital of Changzhou,Changzhou 213000,Jiangsu,China;Department of Physical Therapy,Hospital of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing 210042,China)

机构地区：[1]南京明基医院南京医科大学附属明基医院皮肤科,210019 [2]苏州大学附属第三医院常州市第一人民医院皮肤科,江苏常州213000 [3]中国医学科学院、北京协和医学院皮肤病医院理疗科,南京210042

出　　处：《中华皮肤科杂志》2021年第3期226-228,共3页Chinese Journal of Dermatology

摘　　要：目的观察马血清破伤风抗毒素(TAT)和马破伤风免疫球蛋白F(ab′)2注射后引起的皮肤迟发型变态反应,总结患者的临床特征与处理方法。方法回顾性分析2008—2020年门诊与住院治疗的181例注射TAT或马破伤风免疫球蛋白后出现皮肤迟发型变态反应者的临床资料。结果所有患者注射TAT或马破伤风免疫球蛋白前均行皮试检查,阴性171例(94.47%),阳性10例(5.53%,行脱敏注射)。181例中男118例,女63例,年龄11~68岁,病程1~7 d,潜伏期4~14 d。注射TAT(130例)和马破伤风免疫球蛋白(51例)两组患者的临床表现无显著差异,以荨麻疹样皮疹为主,12例注射部位发生浸润性红斑,其中10例伴有全身荨麻疹。181例中皮疹泛发全身者163例(90.06%),伴有胸闷、发热等系统症状者56例(30.94%),其中15例(26.79%)既往有过敏史,6例症状较重的患者无过敏史。34例(18.78%)出现白细胞计数升高、C反应蛋白升高或尿隐血、尿糖等异常中的单一或多项。抗组胺药与糖皮质激素治疗有效,疗程3~10 d,转归良好。结论TAT或破伤风免疫球蛋白皮试阴性或脱敏治疗的患者仍有可能出现皮肤迟发型变态反应,且以荨麻疹样皮疹为主。Objective To analyze clinical characteristics of cutaneous delayed-type hypersensitivity caused by injection of equine tetanus antitoxin(TAT)or equine anti-tetanus immunoglobulin F(ab′)2.Methods Clinical data were collected from 181 outpatients or inpatients with cutaneous delayed-type hypersensitivity caused by injection of equine TAT or anti-tetanus immunoglobulin from 2008 to 2020,and retrospectively analyzed.Results Before the injection of equine TAT or anti-tetanus immunoglobulin,skin test was negative in 171(94.47%)of the 181 patients,and the 10(5.53%)patients with positive skin test responses received desensitization injection.Among the 181 patients,there were 118 males and 63 females aged from 11 to 68 years,with the disease duration of 1 to 7 days and alatency period of 4 to 14 days.There was no significant difference in the clinical manifestations between the patients receiving injection of TAT(130 cases)and those receiving injection of equine anti-tetanus immunoglobulin(51 cases).Urticaria-like rashes were the main clinical manifestation,and infiltrative erythema occurred at the injection site in 12 patients,of whom 10 developed generalized urticaria all over the body.Of the 181 patients,163(90.06%)presented with generalized skin rashes,and 56(30.94%)had systemic symptoms such as chest tightness,fever,etc,of whom 15(26.79%)had a history of allergies and 6 with severe symptoms had no history of allergies.Thirty-four(18.78%)patients had single or multiple laboratory abnormalities,such as increased white blood cell counts,elevated C-reactive protein level and urinary glucose,and presence of occult blood in urine.All cases responded well to the treatment with antihistamines and glucocorticoids.The treatment duration ranged from 3 to 10 days,and the outcome was good.Conclusion TAT-or anti-tetanus immunoglobulin-induced cutaneous delayed-type hypersensitivity may still occur in patients with a negative skin test or after desensitization treatment,and mainly manifests as urticaria-like rashes.

关 键 词：破伤风抗毒素 免疫球蛋白类 超敏反应 超敏反应 迟发型 药疹 马血清破伤风抗毒素 马破伤风免疫球蛋白F(ab′)2 

分 类 号：R758.2[医药卫生—皮肤病学与性病学]