推荐回答(5个)
皮肤试验属于活体试验,虽然影响因素众多,却能反应机体各种因素综合作用的实际免疫状态;并且简单易行,结果的可信度大;这些优点是其他方法难以替代的,所以在临床和防疫工作中都经常应用。
1.寻找变应原变态反应防治的重要原则之一是回避变应原,而回避的前提是明确变应原,确定变应原的常用方法便是各种类型的皮肤试验。例如支气管哮喘和荨麻疹等均可用皮肤试验来。但食物过敏与皮肤试验的相关性较差,这可能是因为食物的抗原提取液与肠吸收的物质有所不同,或食物过敏并非IgE所介导;而且,食物过敏的变应原容易发现,一般不必作皮肤试验。
2.预防药物或疫苗过敏对患者首次注射某批号的青霉素、链霉素或其它易过敏药物之前,必须做过敏试验;如果患者呈阳性反应(即使是可疑阳性),就应更换其他抗生素。注射导种抗血清(例如抗破伤风血清和抗狂犬病血清)前也必须做过敏试验,如果呈阳性反应就需要换用精制抗体;或进行脱敏治疗(少量多次注射,使抗原逐渐中和血液中的抗体)。
3.评价宿主细胞免疫状态在可疑免疫缺陷病、肿瘤或器官移植进,了解患者的细胞免疫状态对疾病诊断和预后判断都有重要意义。这种情况下可以使用共用抗原结核菌素(OT或PPD)或双链酶(SD-SK)进行皮肤试验;或使用人工合成的二硝基氯苯(DNCB)或二硝基氟苯(DNFB)等先进行致敏再作皮肤试验,这样可消除抗原接触史不同所致的误差。
4.传染病的诊断对某些可疑的传染病,用某种病原体的特异性抗原进行皮肤试验可以起到诊断或鉴别诊断的作用。例如对布氏菌病和软下疳等细菌感染、对某些病毒感染和真菌感染、以及某些寄生虫感染均有一定的意义另外,还有一些反应机制不同于变态反应的中和性皮肤试验,例如诊断白喉的锡克(Schick)试验和诊断猩红热的狄克(Dick)试验等。
皮试是皮肤(或皮内)敏感试验的简称。某些药物在临床使用过程中容易发生过敏反应,如青霉素、链霉素、细胞色素C等,常见的过敏反应包括皮疹、荨麻疹、皮炎、发热、血管神经性水肿、哮喘、过敏性休克等,其中以过敏性休克最为严重,甚至可导致死亡。为了防止过敏反应的发生,特别是严重过敏反应的发生,规定一些容易发生过敏反应的药物在使用前需要做皮肤敏感试验,皮试阴性的药物可以给病人使用,皮试阳性的则禁止使用。
哪些药物需要做皮试?
并不是所有容易过敏的药物都需要做皮试,需要做皮试的药物分为两种类型:一类是按规定必须做皮试的药物;一类是特定情况下才需要做皮试的药物。
必须做皮试的药物还包括两种情况:一种是常规皮试药物,包括青霉素类(注射和口服剂型)、链霉素、结核菌素、皮伤风抗毒素血清、盐酸普鲁卡因、细胞色素C、有机碘造影剂、门冬酰胺酶。无论药品说明书中是否说明要做皮试,这些药物在使用前必须做皮试。另一种是容易过敏的药品,而药品说明书中又要求做皮试的药品(非常规皮试药物),这类药品目前在我院临床使用的有:中诺嘉林(头孢噻酚钠;力芬也是头孢噻酚钠,但说明节没有要求做皮试)、清开灵(冻干粉针)、益替欣(头孢替唑钠)、糜蛋白酶、维生素B1注射液、胸腺肽注射液(过敏体质者需做皮试)。
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