皮下注射变应原免疫治疗所致全身过敏反应的危险因素分析  

Risk factors of systemic allergic reactions caused by subcutaneous allergen immunotherapy

作　　者：李丽莎 关凯 尹佳 王良录 支玉香 孙劲旅 李宏 文利平 汤蕊 顾建青 王子熹 崔乐 徐迎阳 边赛男 Li Lisha;Guan Kai;Yin Jia;Wang Lianglu;Zhi Yuxiang;Sun Jinlü;Li Hong;Wen Liping;Tang Rui;Gu Jianqing;Wang Zixi;Cui Le;Xu Yingyang;Bian Sainan(Department of Allergy,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment on Allergic Diseases,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院变态反应科,过敏性疾病精准诊疗研究北京市重点实验室,北京100730

出　　处：《中华预防医学杂志》2023年第12期1972-1977,共6页Chinese Journal of Preventive Medicine

基　　金：北京市自然科学基金(7222136);国家自然科学基金(82070033);中国医学科学院医学与健康科技创新工程项目(2021-I2M-1-017);中央高水平医院临床科研业务费(2022-PUMCH-B-088,2022-PUMCH-B-089)。

摘　　要：目的探讨在北京协和医院进行变应原皮下注射免疫治疗(subcutaneous immunotherapy,SCIT)注射的患者群体中SCIT所致全身过敏反应的发生率及其危险因素。方法这是一项单中心回顾性队列研究,使用北京协和医院门诊信息系统,回顾性分析从2018年12月至2022年12月在北京协和医院变态反应科进行SCIT注射操作的患者人口学信息及注射相关反应数据,统计SCIT所致全身过敏反应的发生率及危险因素。单因素分析使用Mann-Whitney非参数检验或卡方检验,多因素分析使用多元logistic回归方法。结果四年期间共有2897例患者在变态反应科接受了18070次SCIT注射,发生全身过敏反应40次,总体发生率为0.22%。使用进口尘螨制剂注射时全身过敏反应发生率为0.37%,使用国产多成分变应原制剂注射时全身过敏反应发生率为0.15%。在使用进口尘螨制剂的患者中,年龄小于18岁(OR=3.186,95%CI:1.255~8.085),最高浓度注射(因发生全身过敏反应的患者均注射的是最高浓度,故无法计算OR值),既往注射有大局部反应(OR=22.264,95%CI:8.205~60.411)是与发生SCIT所致全身过敏反应显著相关的危险因素。在使用国产变应原制剂的患者中,注射变应原种类≥5种(OR=3.455,95%CI:1.147~10.402),最高浓度注射(OR=3.794,95%CI:1.226~11.740),既往注射有大局部反应(OR=63.577,95%CI:22.248~181.683)是全身过敏反应的危险因素。而花粉过敏患者在花粉季中进行SCIT注射这一因素,并未显现出与全身过敏反应的相关性。结论在本研究的中国患者群体中,SCIT所致全身过敏反应的发生率低。对于具有使用多种变应原注射、最高浓度注射、既往注射有大局部反应等一种或多种危险因素的患者,应当予以高度重视,警惕其发生全身过敏反应。Objective To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy(SCIT)in patients undergoing SCIT injections in Peking Union Medical College Hospital(PUMCH).Methods This is a single center retrospective cohort study.Using the outpatient information system of PUMCH,the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT.Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis,and multiple logistic regression was used for multiple-factor analysis.Results A total of 2897 patients received 18070 SCIT injections in Allergy Department during the four years,and 40 systemic allergic reactions occurred,with the overall incidence rate of 0.22%.The incidence of systemic allergic reaction was 0.37%when using imported dust mite preparation and 0.15%when using domestic multi-component allergen preparation.The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old(OR=3.186,95%CI:1.255-8.085),highest injection concentration(OR value could not be calculated because all patients with systemic reactions were injected with highest concentration),and large local reaction in previous injection(OR=22.264,95%CI:8.205-60.411).The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens(OR=3.455,95%CI:1.147-10.402),highest injection concentration(OR=3.794,95%CI:1.226-11.740)and large local reaction in previous injection(OR=63.577,95%CI:22.248-181.683).However,SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction.Conclusion The incidence of SCIT-induced systemic allerg

关 键 词：免疫治疗 变应原 皮下注射免疫治疗 全身反应 大局部反应 危险因素 

分 类 号：R593[医药卫生—内科学]