治疗性血浆置换发生过敏反应的危险因素分析——基于单中心的研究  

Risk factors of allergic reactions caused by therapeutic plasma exchange:a single-center analysis

作　　者：李玲玲 朱晓君 林洁[1] 庄远[1] 仇学得 权香 何宗忠 江颖[1] 于洋[1] LI lingling;ZHU Xiaojun;LIN Jie;ZHUANG Yuan;QIU Xuede;QUAN Xiang;HE Zongzhong;JIANG Ying;YU Yang(Department of Blood Transfusion Medicine,The First Medical Center,The General Hospital of PLA,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心输血医学科,北京100853

出　　处：《中国输血杂志》2024年第7期748-753,共6页Chinese Journal of Blood Transfusion

摘　　要：目的 回顾分析治疗性血浆置换(TPE)过程中过敏反应的发生情况,探究TPE过敏反应发生的危险因素。方法 收集2018—2023年由本中心输血医学科完成,且使用了血浆成分的TPE治疗的929例患者的临床资料,采用单因素分析发生过敏反应影响因素,Logistic多因素回归分析发生过敏反应的独立危险因素。结果 929例患者共进行4 071次TPE治疗。其中有198例(21.31%)发生349次(8.57%)过敏反应,其中Ⅰ、Ⅱ、Ⅲ级过敏反应发生率分别为16.33%、81.38%、2.29%,无死亡病例。单因素分析结果显示,患者的年龄、过敏史、是否诊断免疫相关疾病、是否入住ICU、血浆用量、全身血容量、最大血液流速、是否联合使用白蛋白与发生过敏反应有关(P<0.05)。多因素回归分析显示,年轻患者、有过敏史、患免疫相关疾病及非ICU患者容易在TPE中发生过敏反应,而TPE的治疗方案如置换液类别、血浆用量、血液流速等与过敏反应发生无关。结论 TPE发生过敏反应存在明显的个体差异,低龄、有过敏史、患免疫相关疾病及非ICU患者是TPE发生过敏反应的危险因素。TPE治疗前识别出具有危险因素的患者,提前给与相应预防措施,可以降低过敏反应的发生率。Objective To review the occurrence of allergic reactions during therapeutic plasma exchange(TPE) and to explore the risk factors of TPE allergic reactions.Methods The clinical data of 929 patients treated with TPE using plasma components by the Department of Transfusion Medicine in our medical center from 2018 to 2023 were collected.The influencing factors of allergic reactions were analyzed by univariate analysis,and the independent risk factors of allergic reactions were analyzed by logistic multivariate regression analysis.Results A total of 4 071 TPEs were performed in 929 patients.Among them,198 patients(21.31%) experienced 349 times(8.57%) of allergic reactions,with the incidence of grade Ⅰ,Ⅱ and Ⅲ allergic reactions of 16.33%,81.38% and 2.29%,respectively,and no deaths.The univariate analysis showed that the patient′s age,allergy history,diagnosis of immune-related diseases,ICU admission,plasma consumption,total blood volume,maximum blood flow rate and combined use of albumin were related to the occurrence of allergic reactions(P<0.05).Multivariate regression analysis showed that young patients,a history of allergy,immune-related diseases and non-ICU patients were prone to allergic reactions in TPE,but the treatment options of TPE such as substitute fluid category,plasma consumption and blood flow rate were not related to the occurrence of allergic reactions.Conclusion There are significant individual differences in the occurrence of allergic reactions for TPE,and young age,history of allergies,immune-related diseases and non-ICU patients are risk factors for allergic reactions in TPE.Identifying patients with risk factors before TPE treatment and giving corresponding preventive measures can reduce the incidence of allergic reactions.

关 键 词：治疗性血浆置换 不良反应 过敏反应 

分 类 号：R457.1[医药卫生—治疗学]