狂犬病免疫球蛋白在急诊科狂犬病暴露患者中的疗效及其发生不良反应的影响因素分析  

Analysis of the efficacy of rabies immune globulin in rabies-exposed patients in the emergency department and the factors influencing its occurrence of adverse reactions

作　　者：张琳 钟磊 许序云 李永琦 余彦廷 ZHANG Lin;ZHONG Lei;XU Xuyun;LI Yongqi;YU Yanting(Emergency Department,the Third People's Hospital of Kunming/Yunnan Clinical Center for Infectious Diseases,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院/云南省传染性疾病临床医学中心急诊科,云南昆明650041

出　　处：《中国急救复苏与灾害医学杂志》2024年第11期1508-1511,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：云南省卫生健康委临床医学中心2019-2022年建设任务项目(编号:ZX20191103)。

摘　　要：目的 探讨狂犬病免疫球蛋白(HRIG)在急诊科狂犬病暴露患者中的疗效及其发生不良反应的影响因素。方法 选取2019年4月—2023年5月于昆明市第三人民医院注射HRIG的患者753例,按注射后3d内是否出现不良反应分为发生组、未发生组。收集两组一般资料,采用单因素、LASSO、Logistic回归分析HRIG注射后出现不良反应的影响因素。结果 注射7、14 d后狂犬病抗体产生阳性率分别为90.97%(685/753)、98.94%(745/753);注射3 d内不良反应发生率为8.63%(65/753);年龄≤14岁(OR=4.069,95% CI=3.228~5.128)、贫血(OR=3.162,95% CI=1.158~8.633)、重度焦虑(OR=5.379,95% CI=2.749~10.524)、重度疼痛(OR=4.056,95% CI=1.052~15.635)、夏季注射(OR=5.858,95% CI=5.212~6.585)、注射后针口碰水(OR=5.892,95% CI=1.863~18.633)、注射后饮食清淡(OR=0.325,95% CI=0.252~0.419)是狂犬病暴露患者注射HRIG后发生不良反应的影响因素(P<0.05)。结论 HRIG在急诊科狂犬病暴露患者中疗效显著,但注射后仍存在不良反应发生风险,年龄≤14岁、贫血、重度焦虑、重度疼痛、夏季注射、注射后针口碰水、注射后饮食清淡是HRIG注射后发生不良反应的影响因素,临床可据此制定针对性防治措施,降低不良反应发生率。Objective To investigate the efficacy of rabies immunoglobulin(HRIG) in rabies-exposed patients in the emergency department and the influencing factors of its occurrence of adverse reactions.Methods A total of 753 patients who received HRIG injection in the Third People's Hospital of Kunming from April 2019 to May 2023 were selected and divided into occurrence group and non-occurrence group according to whether adverse reactions occurred within 3 days after injection.The general data of the two groups were collected,and the influencing factors of adverse reactions after HRIG injection were analyzed by single factor,LASSO and Logistic regression.Results The positive rates of rabies antibody were 90.97%(685/753) and 98.94%(745/753) after 7 and 14 days of injection,respectively.The incidence of adverse reactions within 3 days of injection was 8.63%(65/753).Age ≤14 years old(OR=4.069,95% CI=3.228-5.128),anemia(OR=3.162,95% CI=1.158-8.633),severe anxiety(OR=5.379,95% CI= 2.749-10.524),severe pain(OR=4.056,95% CI=1.052-15.635),injection in summer(OR=5.858,95% CI=5.212-6.585),water contact at the needle mouth after injection(OR=5.892,95% CI=1.863-18.633),light diet after injection(OR=0.325,95% CI=0.252-0.419) was the influential factor for adverse reactions after HRIG injection in rabies exposed patients(P<0.05).Conclusion HRIG is effective in patients exposed to rabies in the emergency department,but there is still a risk of adverse reactions after injection.Age ≤14 years old,anemia,severe anxiety,severe pain,summer injection,water on the needle mouth after injection,and light diet after injection are the influential factors for adverse reactions after HRIG injection,and clinical prevention and treatment measures can be formulated accordingly.Reduce the incidence of adverse reactions.

关 键 词：狂犬病 狂犬病免疫球蛋白 疗效 不良反应 影响因素 LOGISTIC回归分析 

分 类 号：R392[医药卫生—免疫学]