332 683例CT增强检查患者非离子碘对比剂急性不良反应情况及其影响因素分析

邱海燕; 王羚入; 李建洁; 陈兰; 李雪

doi:10.16016/j.2097-0927.202208068

您当前的位置：

首页 >

文章列表页 >

332 683例CT增强检查患者非离子碘对比剂急性不良反应情况及其影响因素分析

临床医学 | 更新时间：2026-01-09

- 332 683例CT增强检查患者非离子碘对比剂急性不良反应情况及其影响因素分析
- Acute adverse reactions and influencing factors of non-ionic iodine contrast in 332 683 patients undergoing contrast-enhanced CT scanning
- 陆军军医大学学报 2023年45卷第3期页码：257-264
- 作者机构：
  
  400042 重庆，陆军特色医学中心放射科
- 作者简介：
  
  [ 李雪，E-mail: lixue928136@163.com LI Xue, E-mail: lixue928136@163.com
- 基金信息：
  
  重庆市科卫联合医学科研项目(2019ZDXM049)
- DOI：10.16016/j.2097-0927.202208068
  中图分类号： R181.22;R595.4;R981.1
- 收稿：2022-08-09，
  
  修回：2022-09-20，
  
  纸质出版：2023-02-15
- 稿件说明：
移动端阅览
邱海燕, 王羚入, 李建洁, 等. 332 683例CT增强检查患者非离子碘对比剂急性不良反应情况及其影响因素分析[J]. 陆军军医大学学报, 2023,45(3):257-264.

Haiyan QIU, Lingru WANG, Jianjie LI, et al. Acute adverse reactions and influencing factors of non-ionic iodine contrast in 332 683 patients undergoing contrast-enhanced CT scanning[J]. Journal of Army Medical University, 2023, 45(3): 257-264.
邱海燕, 王羚入, 李建洁, 等. 332 683例CT增强检查患者非离子碘对比剂急性不良反应情况及其影响因素分析[J]. 陆军军医大学学报, 2023,45(3):257-264. DOI： 10.16016/j.2097-0927.202208068.

Haiyan QIU, Lingru WANG, Jianjie LI, et al. Acute adverse reactions and influencing factors of non-ionic iodine contrast in 332 683 patients undergoing contrast-enhanced CT scanning[J]. Journal of Army Medical University, 2023, 45(3): 257-264. DOI： 10.16016/j.2097-0927.202208068.

摘要

目的

分析真实世界中非离子碘对比剂(iodinated contrast medium，ICM)急性不良反应(acute adverse reactions，AARs)的发生情况及影响因素。

方法

采用回顾性病例对照研究，纳入2014-2020年在陆军特色医学中心使用ICM行CT增强检查的332 683例患者，其中男性184 498例，女性148 185例，年龄0~101(57.91±14.36)岁，根据是否发生AARs分为病例组和对照组。采用单因素和多因素Logistic回归分析筛出发生ICM-AARs的影响因素。

结果

病例组931例(发生ICM-AARs者)，对照组331 752例(未发生ICM-AARs者)。ICM-AARs总发生率为0.28%，其中轻度、中度、重度AARs分别占93.88%、4.83%、1.29%。回归分析结果显示，既往有ICM不良反应发生史(

=22.881

95%

: 16.235~32.246)、其他过敏史(

=4.406

95%

: 2.338~8.303)、患有哮喘(

=5.614

95%

: 2.596~12.138)与ICM-AARs的关联强度较强(

0.05)，性别、来源、药物过敏史、ICM类型和注射速度5个危险因素和高龄、ICM使用史、高血压病史3个保护因素(

=0.396~1.674)与ICM-AARs的关联强度较弱(

0.05)。

结论

ICM-AARs发生率为0.28%，以轻度不良反应为主。既往有ICM不良反应发生史、其他过敏史、哮喘是ICM-AARs发生的主要影响因素。

Abstract

Objective

To analyze the incidence and influencing factors of acute adverse reactions (AARs) of non-ionic iodine contrast medium (ICM) in the real world.

Methods

A retrospective case-control study was carried out on 332 683 patients receiving ICM-enhanced CT examination at our medical center from 2014 to 2020. They were 184 498 males and 148 185 females

at an age from 0 to 101 (57.91±14.36) years. According to experiencing AARs or not

the patients were divided into case group (ICM-AARs

=931) and control group (no ICM-AARs

=331 752). Single factor and multi factor logistic regression analyses were used to screen out the influencing factors of ICM-AARs.

Results

In the cohort

the incidence of ICM-AARs was 0.28% (931/332 683)

with mild

moderate and severe AARs accounted for 93.88%

4.83% and 1.29%

respectively. The results of regression analysis showed that history of ICM adverse reactions (

=22.881

95%

: 16.235~32.246)

history of other allergies (

=4.406

95%

: 2.338~8.303) and asthma (

=5.614

95%

: 2.596~12.138) were closely associated with the occurrence of ICM-AARs (

0.05). Gender

source

history of drug allergy

ICM type and injection speed were risk factors

while older age

history of ICM use and hypertension history were protective factors (

=0.396~1.674

0.05)

but the strengths of above associations with the ICM-AARs were relatively weak (

0.05).

Conclusion

The incidence of ICM-AARs is 0.28%

mainly mild adverse reactions. Previous history of ICM adverse reactions

other allergies

and asthma are the main factors affecting the occurrence of ICM-AARs.

关键词

Keywords

references

BÖHM I, MORELLI J, NAIRZ K, et al . Myths and misconceptions concerning contrast media-induced anaphylaxis: a narrative review[J ] . Postgrad Med, 2017, 129(2): 259-266. DOI: 10.1080/00325481.2017.1282296.

PARK H K, KANG M G, YANG M S, et al . Epidemiology of drug-induced anaphylaxis in a tertiary hospital in Korea[J ] . Allergol Int, 2017, 66(4): 557-562. DOI: 10.1016/j.alit.2017.02.008.

BAE K, LEE S M, HA J Y, et al . Adverse drug reactions to CT contrast media in south Korea: incidence and risk factors[J ] . J Korean Soc Radiol, 2016, 75(1): 41. DOI: 10.3348/jksr.2016.75.1.41.

LI X, CHEN J, ZHANG L, et al . Clinical observation of the adverse drug reactions caused by non-ionic iodinated contrast media: results from 109, 255 cases who underwent enhanced CT examination in Chongqing, China[J ] . Br J Radiol, 2015, 88(1047): 20140491. DOI: 10.1259/bjr.20140491.

SODAGARI F, MOZAFFARY A, WOOD C G 3rd, et al . Reactions to both nonionic iodinated and gadolinium-based contrast media: incidence and clinical characteristics[J ] . AJR Am J Roentgenol, 2018, 210(4): 715-719. DOI: 10.2214/AJR.17.18655.

WYSOWSKI D K, NOURJAH P. Deaths attributed to X-ray contrast media on US death certificates[J]. AJR Am J Roentgenol, 2006, 186(3): 613-615. DOI: 10.2214/AJR.04.1790.

KAITO D, HOMMA K, SASAKI J. Rapid collapse of the inferior vena cava in a patient with cardiac arrest induced by anaphylactic shock after iodinated contrast medium injection[J]. J Am Coll Emerg Physicians Open, 2020, 1(4): 379-382. DOI: 10.1002/emp2.12166.

常春兰, 彭繁. 证据: 从随机对照试验回归真实世界: 从新冠疫情中最佳证据缺失谈起[J]. 山东社会科学, 2022(6): 101-107. DOI: 10.14112/j.cnki.37-1053/c.2022.06.023.

CHANG C L, PENG F. The evidence: From randomized controlled trials to the real world: The best evidence is missing from the COVID-19 pandemic[J]. Shandong Soc Sci, 2022(6): 101-107. DOI: 10.14112/j.cnki.37-1053/c.2022.06.023.

[European Society of Urogenital Radiology. ESUR guidelines on contrast agents[E B/OL ] . [2022-08-30 ] . http://www.esur.org/fileadmin/content/2019/ESUR_Guidelines_10.0_Final_Version.pdf http://www.esur.org/fileadmin/content/2019/ESUR_Guidelines_10.0_Final_Version.pdf .

[ACR Committee on Drugs and Contrast Media (2017). ACR manual on contrast media, v10.3. American College of Radiology[EB/OL ] . [2022-09-20 ] . https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf , 2017.

中华医学会放射学分会放射护理专业委员会放射诊断护理学组. 影像科碘对比剂输注安全专家共识[J]. 介入放射学杂志, 2018, 27(8): 707-712. DOI: 10.3969/j.issn.1008-794X.2018.08.001.

Radiological Diagnostic Nursing Group, Professional Committee on Radiological Nursing Care, Radiology Branch of Chinese Medical Association. Expert consensus on the safety of iodine contrast agent infusion in imaging department[J]. J Interv Radiol, 2018, 27(8): 707-712. DOI: 10.3969/j.issn.1008-794X.2018.08.001.

张辉. 碘对比剂急性不良反应危险因素分析及与IgE, 嗜酸性粒细胞, 血糖等相关性研究[D]. 郑州: 郑州大学, 2021.

ZHANG H. Analysis of risk factors of acute adverse reaction to iodinated contrast media and investigating the correlation with IgE, eosinophils andblood glucose[D]. Zhengzhou: Zhengzhou University, 2021.

PALKOWITSCH P K, BOSTELMANN S, LENGSFELD P. Safety and tolerability of iopromide intravascular use: a pooled analysis of three non-interventional studies in 132, 012 patients[J]. Acta Radiol, 2014, 55(6): 707-714. DOI: 10.1177/0284185113504753.

NARITA S, GOLDBLUM R M, WATSON C S, et al . Environmental estrogens induce mast cell degranulation and enhance IgE-mediated release of allergic mediators[J ] . Environ Health Perspect, 2007, 115(1): 48-52. DOI: 10.1289/ehp.9378.

甘淼, 刘畅, 赵丽, 等. CT对比剂急性不良反应的相关因素分析[J]. 中国医科大学学报, 2020, 49(5): 458-462. DOI: 10.12007/j.issn.0258-4646.2020.05.016.

GAN M, LIU C, ZHAO L, et al . Analysis of related factors of acute adverse reaction caused by contrast agents used in computed tomography[J ] . J China Med Univ, 2020, 49(5): 458-462. DOI: 10.12007/j.issn.0258-4646.2020.05.016.

朱春燕, 郭晴, 田庆丰, 等. 河南省老年人综合能力失能现况及影响因素研究[J]. 中国全科医学, 2021, 24(12): 1500-1505. DOI: 10.12114/j.issn.1007-9572.2021.00.169.

ZHU C Y, GUO Q, TIAN Q F, et al . Prevalence and influencing factors of comprehensive disability in the elderly in Henan Province[J ] . Chin Gen Pract, 2021, 24(12): 1500-1505. DOI: 10.12114/j.issn.1007-9572.2021.00.169.

WOO S D, YOON J, DOO G E, et al . Common causes and characteristics of adverse drug reactions in older adults: a retrospective study[J ] . BMC Pharmacol Toxicol, 2020, 21(1): 87. DOI: 10.1186/s40360-020-00464-9.

MORTELÉ K J, OLIVA M R, ONDATEGUI S, et al . Universal use of nonionic iodinated contrast medium for CT: evaluation of safety in a large urban teaching hospital[J ] . AJR Am J Roentgenol, 2005, 184(1): 31-34. DOI: 10.2214/ajr.184.1.01840031.

CHA M J, KANG D Y, LEE W, et al . Hypersensitivity reactions toiodinated contrast media: a multicenter study of 196 081 patients[J ] . Radiology, 2019, 293(1): 117-124. DOI: 10.1148/radiol.2019190485.

ZHAI L Q, GUO X J, ZHANG H Y, et al . Non-ionic iodinated contrast media related immediate reactions: a mechanism study of 27 patients[J ] . Leg Med (Tokyo), 2017, 24: 56-62. DOI: 10.1016/j.legalmed.2016.11.006.

BOEHM I. Contrast medium and patients at risk: asthma[J]. Acta Radiol, 2009, 50(3): 348. DOI: 10.1080/02841850902729885.

BÖHM I, SPECK U, SCHILD H. Cell-dependent influence on the phagocytosis induced by non-ionic contrast medium injection[J]. Br J Radiol, 2008, 81(963): 199-203. DOI: 10.1259/bjr/13906058.

BERGSTRA A, VAN DIJK R B, BREKKE O, et al . Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function[J ] . Catheter Cardiovasc Interv, 2000, 50(3): 314-321. DOI: 10.1002/1522-726x(200007)50:3314:aid-ccd9 > 3.0.co;2-d.

樊明, 潘静. CT增强扫描注射碘对比剂后血流动力学指标的动态变化[J]. 临床放射学杂志, 2018, 37(12): 2096-2099. DOI: 10.13437/j.cnki.jcr.2018.12.041.

FAN M, PAN J. Dynamic changes of hemodynamic indexes in patients injecting iodine contrast media for CT examination[J]. J Clin Radiol, 2018, 37(12): 2096-2099. DOI: 10.13437/j.cnki.jcr.2018.12.041.

WIDMANN G, BALE R, ULMER H, et al . Systemic hypotension following intravenous administration of nonionic contrast medium during computed tomography: iopromide versus iodixanol[J ] . Anesth Analg, 2018, 126(3): 769-775. DOI: 10.1213/ANE.0000000000002346.

MORCOS S K, DAWSON P, PEARSON J D, et al . The haemodynamic effects of iodinated water soluble radiographic contrast media: a review[J ] . Eur J Radiol, 1998, 29(1): 31-46 . DOI: 10.1016/s0720-048x(98)00018-7.

[国家药品监督管理局药品审评中心. 国家药监局药审中心关于发布《用于产生真实世界证据的真实世界数据指导原则(试行)》的通告(2021年第27号)[EB/OL ] . (2021-04-13)[2021-07-20 ] . https://www.cde.org.cn/main/news/viewInfoCommon/2a1c437ed54e7b838a7e86f4ac21c539 https://www.cde.org.cn/main/news/viewInfoCommon/2a1c437ed54e7b838a7e86f4ac21c539 .

[Center for Drug Evaluation of National Medical Products Administration. Administration on the Release of "Guidelines for Real-World Data Used to Generate Real-World Evidence (Trial)" (No. 27, 2021)[EB/OL ] . (2021-04-13)[2021-07-20 ] . https://www.cde.org.cn/main/news/viewInfoCommon/2a1c437ed54e7b838a7e86f4ac21c539 https://www.cde.org.cn/main/news/viewInfoCommon/2a1c437ed54e7b838a7e86f4ac21c539 .

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

直肠癌术后回肠造口还纳患者发生低位前切除综合征的影响因素分析

肾移植受者运动恐惧潜在剖面分析及影响因素研究

在真实世界中使用2 L和3 L聚乙二醇电解质溶液进行肠道准备的效果比较

经腹、经阴道超声介入穿刺硬化治疗卵巢巧克力囊肿术中疼痛影响因素分析