改用钆基对比剂预防复发性急性药物不良反应：使用倾向评分匹配的 6 年队列研究。
Changing Gadolinium-Based Contrast Agents to Prevent Recurrent Acute Adverse Drug Reactions: 6-Year Cohort Study Using Propensity Score Matching.
机构信息
University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
出版信息
Korean J Radiol. 2024 Sep;25(9):824-832. doi: 10.3348/kjr.2024.0248.
OBJECTIVE
To determine the preventive effect of changing gadolinium-based contrast agents (GBCAs) to reduce the recurrence of GBCA-associated acute adverse drug reactions (ADRs).
MATERIALS AND METHODS
This retrospective, observational, single-center study-conducted between January 2016 and December 2021-included 238743 consecutive GBCA-enhanced MRI examinations. We focused on a subgroup of patients who experienced acute GBCA-associated ADRs during any of these examinations and subsequently underwent follow-up GBCA-enhanced MRI examinations up until July 2023. The follow-up examinations involved either the same (non-change group) or different (change group) GBCAs compared to the ones that initially caused the acute ADR. Baseline participant characteristics, generic profile of the GBCAs, administration of premedication, history of prior ADR to iodinated contrast media, and symptoms of GBCA-associated acute ADRs were retrospectively analyzed. Multivariable logistic regression with generalized estimating equations and propensity score matching were used.
RESULTS
A total of 1042 instances of acute ADRs (0.44%; 95% confidence interval [CI]: 0.41%-0.46%) were reported. Three-hundred and seventy-three patients underwent GBCA-enhanced MRI examinations after experiencing GBCA-associated acute ADRs within the study period; 31.9% (119/373) reexperienced acute ADRs at any of the follow-up examinations. The ADR recurrence was significantly lower in the GBCA change group than in the non-change group according to multivariable logistic regression (adjusted odds ratio [OR]: 0.35; 95% CI: 0.13-0.90; = 0.03) and analysis with propensity score matching (14.3% [6/42] vs. 36.9% [31/84], respectively; OR: 0.32, 95% CI: 0.11-0.94; = 0.04). A history of an ADR to iodinated contrast media (OR: 1.14, 95% CI: 0.68-1.90; = 0.62) and premedication (adjusted OR: 2.09, 95% CI: 0.93-4.68; = 0.07) were not significantly associated with GBCA-associated acute ADR recurrence. A separate analysis for recurrent allergic-like hypersensitivity reactions demonstrated similar results (adjusted OR: 0.20, 95% CI: 0.06-0.65; < 0.01).
CONCLUSION
Changing GBCAs may reduce the risk of GBCA-associated acute ADR recurrence.
目的
确定更换钆基对比剂（GBCA）以降低 GBCA 相关性急性药物不良反应（ADR）复发的预防效果。
材料和方法
这是一项回顾性、观察性、单中心研究，于 2016 年 1 月至 2021 年 12 月进行，共纳入 238743 例连续接受 GBCA 增强 MRI 检查的患者。我们重点关注在这些检查中任何一次检查中发生急性 GBCA 相关性 ADR 的患者亚组，并在 2023 年 7 月之前进行后续 GBCA 增强 MRI 检查。随访检查使用的 GBCA 与最初引起急性 ADR 的 GBCA 相同（非更改组）或不同（更改组）。回顾性分析了患者的基线特征、GBCA 的一般特征、预处理用药、既往碘造影剂 ADR 史以及 GBCA 相关性急性 ADR 的症状。使用广义估计方程和倾向评分匹配的多变量逻辑回归进行分析。
结果
共报告了 1042 例急性 ADR（0.44%；95%置信区间[CI]：0.41%-0.46%）。在研究期间经历 GBCA 相关性急性 ADR 的 373 例患者进行了 GBCA 增强 MRI 检查；其中 31.9%（119/373）在任何一次随访检查中再次发生急性 ADR。多变量逻辑回归分析（调整后的优势比[OR]：0.35；95%CI：0.13-0.90； = 0.03）和倾向评分匹配分析（分别为 14.3%[6/42]和 36.9%[31/84]；OR：0.32，95%CI：0.11-0.94； = 0.04）均显示，GBCA 更换组的 ADR 复发率明显低于非更换组。有碘造影剂 ADR 史（OR：1.14，95%CI：0.68-1.90； = 0.62）和预处理（调整后的 OR：2.09，95%CI：0.93-4.68； = 0.07）与 GBCA 相关性急性 ADR 复发无显著相关性。对复发性过敏样超敏反应的单独分析也得到了类似的结果（调整后的 OR：0.20，95%CI：0.06-0.65； ＜0.01）。
结论
更换 GBCA 可能降低 GBCA 相关性急性 ADR 复发的风险。
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