冠状动脉CT血管成像碘过敏反应的注册登记研究单中心结果报告

摘要

＿目的：探讨行冠状动脉CT血管成像（CCTA）时使用碘对比剂的急性速发型过敏反应发生率及其程度，并对过敏反应在患者性别、年龄和危险因素分布的差异作出初步分析。方法：本组共入选接受 CCTA 检查的连续患者37109例，男22636例（61％），女14473例（39％），年龄27～85岁（平均53．2±12．7岁）。根据Ring和Messmer提出的碘过敏反应诊断标准，将急性速发型（＜60 min）过敏反应由轻到重分为Ⅰ～Ⅳ级，登记患者的过敏反应发病情况。独立样本采用t检验，分类变量比较采用卡方检验。结果：37109例患者中共发生急性速发型过敏反应124例（0．334％），其中Ⅰ～Ⅳ级所占比率分别为96．774％（120／124），2．419％（3／124），0．806％（1／124）和0。Ⅰ～Ⅳ级过敏反应在所有患者中的发生率分别为0．323％（120／37109）、0．008％（3／37109）、0．003％（1／37109）和0（χ2＝214．345，P＜0．001）。进一步分层显示男性过敏反应发生率为0．314％（71／22636），与女性的发生率0．366％（53／14473）差异没有统计学意义（χ2＝0．732，P＝0．392）；以本组平均年龄为53岁分组，低年龄组（＜53岁）过敏反应发生率为0．335％（51／15238），与高年龄组（≥53岁）的发生率0．334％（73／21871）差异没有统计学意义（χ2＝0．432，P＝0．926）。过敏组患者在哮喘、食物过敏史、碘过敏史及肾功能不全的发病率均高于无过敏患者，两组间差异具有统计学意义（P 均＜0．05）。结论：行CCTA 扫描时常规使用的碘对比剂有一定的急性速发型过敏反应发生，但发生率低且多为轻度的 I 级；碘过敏发生率在不同性别和年龄组并非存在差异，但在有哮喘、食物过敏史、碘过敏史及肾功能不全的高危险因素患者中的发病率较高。%_Objective:The purpose of this report was to investigate the incidence and severity of acute anaphylactic re-actions to iodinated contrast media for coronary computed tomography angiography (CCTA)scan,and to preliminarily ana-lyze the differences of this condition among gender,age,and risk factors in subgroups.Methods:A total of 37109 consecutive patients,aged from 27 to 85 years (53.2±12.7 years),who had undergone CCTA were included to this study,including 22636 male (61%)and 14473 female (39%).Based upon ring and Messmer's definition of diagnosis,only the patients with acute hypersensitive reaction (within 60 minutes)were selected and classified as grade Ⅰ to Ⅳ for analysis.Independent-samples were analyzed using student t tests,and categorized variables were compared using chi-square tests.Results:As for the 37109 cases,124 (0.334%)patients had anaphylactic reactions,with grade Ⅰ 96.774% (120/124),grade Ⅱ 2.419%(3/124),grade Ⅲ,0.806% (1/124)and grade Ⅳ0,respectively,from the mildest to most severe.The incidence of grade Ⅰto Ⅳ were 0.323% (120/37109),0.008% (3/37109),0.003% (1/37109)and 0 for the whole group (χ2= 214.345,P<0.001).Stratified by gender,the incidence in male (0.314%,71/22636)had no significant difference with it in female (0.366%,53/14473)(χ2= 0.732,P= 0.392).In younger subgroup (age<53 years),the incidence was 0.335% (51/15238),whereas the incidence of older (≥53 years)subgroup was 0.334% (73/21871),the incidence showed no significant difference (χ2= 0.432,P= 0.926).Patients with acute anaphylactic reactions had more risk factors such as asthma,food al-lergy,history of iodine allergy,and renal dysfunction compared to negative group (P<0.05).Conclusion:For CCTA exami-nation,the occurrence of acute anaphylactic reactions to iodine contrast media is relatively low and mild.There is no signifi-cant differences in gender and age subgroups.However,patients with history of allergic risk factors and renal dysfunction have higher possibility of occurrence.