静脉注射头孢菌素类药物患者过敏反应发生率及其影响因素的多中心临床研究  

A multicenter clinical study on the incidence and influencing factors of cephalosporin-induced anaphylaxis

作　　者：阳平[1,2,3] 戴单单 李晴宇 詹海潮 李旭梅[7] 芦小燕 何敏[9] 陈娜[1,2,3] 姜赛平[1,2,3] 卢晓阳 YANG Ping;DAI Dandan;LI Qingyu;ZHAN Haichao;LI Xumei;LU Xiaoyan;HE Min;CHEN Na;JIANG Saiping;LU Xiaoyang(Department of Clinical Pharmacy,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research,Hangzhou 310003,China;Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Clinical Evaluation and Translational Research,Hangzhou 310003,China;Department of Pharmacy,the First Affiliated Hospital of Ningbo University,Ningbo 315000,Zhejiang Province,China;Department of Clinical Pharmacy,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Clinical Pharmacy,Jinhua Central Hospital,Jinhua 321000,Zhejiang Province,China;Department of Clinical Pharmacy,the Second Hospital of Jiaxing,Jiaxing 314001,Zhejiang Province,China;Department of Clinical Pharmacy,Ningbo Second Hospital,Ningbo 315010,Zhejiang Province,China;Department of Clinical Pharmacy,Department of Clinical Pharmacy,Xiaoshan District First People’s Hospital,Hangzhou 311200,China)

机构地区：[1]浙江大学医学院附属第一医院临床药学科,浙江杭州310003 [2]浙江省药物评价与临床研究重点实验室,浙江杭州310003 [3]浙江省中药临床评价与转化研究重点实验室,浙江杭州310003 [4]宁波大学第一附属医院药学部,浙江宁波315000 [5]浙江大学医学院附属杭州市第一人民医院药学部,浙江杭州310006 [6]金华市中心医院药学部,浙江金华321000 [7]嘉兴市第二医院药学部,浙江嘉兴314001 [8]宁波市第二医院药学部,浙江宁波315010 [9]杭州市萧山区第一人民医院临床药学科,浙江杭州311200

出　　处：《浙江大学学报（医学版）》2024年第5期615-622,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省医学会临床医学科研基金(2020ZYC-A107)。

摘　　要：目的:分析头孢菌素类药物过敏反应的发生率及其影响因素。方法:横断面调研2021年4月1日至6月30日浙江省29家医疗机构所有接受静脉注射头孢菌素类药物的患者,统计头孢菌素类药物过敏反应的发生率,采用泊松回归模型分析头孢菌素类药物诱导过敏反应发生的相关影响因素。结果:研究共纳入56155例患者,头孢菌素类药物过敏反应总发生率为1.67‰,过敏反应发生率最高的是头孢唑肟(4.27‰),其次是头孢曲松(3.49‰)和头孢噻肟(2.40‰)。与皮试阴性组比较,非皮试组患者过敏反应发生率无明显增加(分别为1.75‰与1.63‰,RR=1.07,95%CI:0.70~1.63,P>0.05)。泊松回归分析结果显示,体重指数低于18.5 kg/m^(2)(RR=2.43,95%CI:1.23~4.82,P<0.05)、其他β-内酰胺类药物过敏史(RR=33.88,95%CI:1.47~781.12,P<0.05)会增加头孢菌素类药物过敏反应的发生率,且与头孢呋辛比较,头孢曲松(RR=3.08,95%CI:1.70~5.59,P<0.01)、头孢他啶(RR=1.89,95%CI:1.03~3.47,P<0.05)和头孢唑肟(RR=3.74,95%CI:1.64~8.50,P<0.01)过敏反应发生的风险增加。结论:头孢菌素类药物过敏反应与低体重指数和β-内酰胺类药物过敏史有关,头孢菌素类药物的常规皮试筛查并不能减少过敏反应发生。Objective:To investigate the incidence and influencing factors of allergic reactions to cephalosporins.Methods:A cross-sectional study of 29 medical institutions in Zhejiang Province was conducted from April 2021 to June 2021.The incidence of allergic reactions to cephalosporins was investigated,and the influencing factors of cephalosporin-induced allergic reactions were analyzed by Poisson regression.Results:A total of 56155 patients were included in this study.The total incidence of allergic reactions to cephalosporin was 1.67‰,the highest incidence of anaphylaxis occurred for ceftizoxime(4.27‰),followed by ceftriaxone(3.49‰)and cefotaxime(2.40‰).There was no significant difference in the incidence of allergic reactions between patients with negative skin tests and those without skin tests(1.75‰vs.1.63‰,RR=1.07,95%CI:0.70-1.63,P>0.05).Poisson regression showed that body mass index(BMI)<18.5 kg/m^(2)(RR=2.43,95%CI:1.23-4.82,P<0.05)and history ofβ-lactam antibiotics allergy(RR=33.88,95%CI:1.47-781.12,P<0.05)increased cephalosporininduced anaphylaxis.Compared with cefuroxime,the risk of allergic reactions was increased for ceftriaxone(RR=3.08,95%CI:1.70-5.59,P<0.01),ceftazidime(RR=1.89,95%CI:1.03-3.47,P<0.05),and ceftizoxime(RR=3.74,95%CI:1.64-8.50,P<0.01).Conclusions:Lower BMI and history ofβ-lactam antibiotics allergy increase the risk of cephalosporin allergic reactions.The routine skin test may not reduce the occurrence of allergic reactions to cephalosporins.

关 键 词：头孢菌素 皮试 过敏反应 体重指数 Β-内酰胺类药物 

分 类 号：R978.11[医药卫生—药品]