Abe Shoko, Fukuda Hozumi, Tobe Kimiko, Ibukuro Kenji
Department of Diagnostic Radiology, Mitsui Memorial Hospital, 1 Kandaizumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
Eur Radiol. 2016 Jul;26(7):2148-54. doi: 10.1007/s00330-015-4028-1. Epub 2015 Oct 1.
The purpose of this study was to assess the protective effect of premedication and changing contrast media (CM) against repeat adverse reactions (ARs) to iodinated CM.
Between January 2006 and September 2014, 771 cases with previous ARs to CM were administered CM. The same CM that had caused ARs previously was administered to 491 cases (220 without premedication [defined as the control group], and 271 with premedication [the premedication alone group]). A different CM from the previous CM was given to 280 cases (58 without premedication [the changing CM alone group], and 222 with premedication [the premedication and changing CM group]).
The control group had 61 repeat ARs (27.7%). The premedication alone group had 47 ARs (17.3%, p<0.01). The changing CM alone group had 3 ARs (5.2%, p<0.001). Three ARs (7.9%) were observed in 38 cases changing from one to another low-osmolar nonionic CM. Twenty cases with previous ARs to the high-osmolar CM and to the low-osmolar ionic CM showed no ARs. The premedication and changing CM group had 6 ARs (2.7%, p<0.001).
Premedication prior to contrast for patients with previous ARs may be protective, however, changing CM was more effective.
• In patients with previous adverse reactions, changing contrast media is recommended. • Premedication is unnecessary against previous reactions to high-osmolar or ionic CM. • Changing from one to another low-osmolar non-ionic CM may be effective.
本研究旨在评估预处理及更换造影剂（CM）对碘化CM重复不良反应（ARs）的保护作用。
2006年1月至2014年9月期间，对771例既往有CM相关ARs的患者使用了CM。将之前引起ARs的相同CM给予491例患者（220例未进行预处理[定义为对照组]，271例进行了预处理[仅预处理组]）。将与之前不同的CM给予280例患者（58例未进行预处理[仅更换CM组]，222例进行了预处理[预处理及更换CM组]）。
对照组有61例重复ARs（27.7%）。仅预处理组有47例ARs（17.3%，p<0.01）。仅更换CM组有3例ARs（5.2%，p<0.001）。在38例从一种低渗非离子型CM更换为另一种低渗非离子型CM的患者中观察到3例ARs（7.9%）。20例既往对高渗CM和低渗离子型CM有ARs的患者未出现ARs。预处理及更换CM组有6例ARs（2.7%，p<0.001）。
对于既往有ARs的患者，造影前进行预处理可能具有保护作用，然而，更换CM更有效。
• 对于既往有不良反应的患者，建议更换造影剂。• 对于既往对高渗或离子型CM的反应，无需进行预处理。• 从一种低渗非离子型CM更换为另一种低渗非离子型CM可能有效。
