摘要目的:观察马血清破伤风抗毒素（TAT）和马破伤风免疫球蛋白F（ab′）2注射后引起的皮肤迟发型变态反应，总结患者的临床特征与处理方法。方法:回顾性分析2008—2020年门诊与住院治疗的181例注射TAT或马破伤风免疫球蛋白后出现皮肤迟发型变态反应者的临床资料。结果:所有患者注射TAT或马破伤风免疫球蛋白前均行皮试检查，阴性171例（94.47%），阳性10例（5.53%，行脱敏注射）。181例中男118例，女63例，年龄11~68岁，病程1~7 d，潜伏期4~14 d。注射TAT（130例）和马破伤风免疫球蛋白（51例）两组患者的临床表现无显著差异，以荨麻疹样皮疹为主，12例注射部位发生浸润性红斑，其中10例伴有全身荨麻疹。181例中皮疹泛发全身者163例（90.06%），伴有胸闷、发热等系统症状者56例（30.94%），其中15例（26.79%）既往有过敏史，6例症状较重的患者无过敏史。34例（18.78%）出现白细胞计数升高、C反应蛋白升高或尿隐血、尿糖等异常中的单一或多项。抗组胺药与糖皮质激素治疗有效，疗程3~10 d，转归良好。结论:TAT或破伤风免疫球蛋白皮试阴性或脱敏治疗的患者仍有可能出现皮肤迟发型变态反应，且以荨麻疹样皮疹为主。

abstractsObjective:To analyze clinical characteristics of cutaneous delayed-type hypersensitivity caused by injection of equine tetanus antitoxin (TAT) or equine anti-tetanus immunoglobulin F (ab′) 2. Methods:Clinical data were collected from 181 outpatients or inpatients with cutaneous delayed-type hypersensitivity caused by injection of equine TAT or anti-tetanus immunoglobulin from 2008 to 2020, and retrospectively analyzed.Results:Before the injection of equine TAT or anti-tetanus immunoglobulin, skin test was negative in 171 (94.47%) of the 181 patients, and the 10 (5.53%) patients with positive skin test responses received desensitization injection. Among the 181 patients, there were 118 males and 63 females aged from 11 to 68 years, with the disease duration of 1 to 7 days and alatency period of 4 to 14 days. There was no significant difference in the clinical manifestations between the patients receiving injection of TAT (130 cases) and those receiving injection of equine anti-tetanus immunoglobulin (51 cases) . Urticaria-like rashes were the main clinical manifestation, and infiltrative erythema occurred at the injection site in 12 patients, of whom 10 developed generalized urticaria all over the body. Of the 181 patients, 163 (90.06%) presented with generalized skin rashes, and 56 (30.94%) had systemic symptoms such as chest tightness, fever, etc, of whom 15 (26.79%) had a history of allergies and 6 with severe symptoms had no history of allergies. Thirty-four (18.78%) patients had single or multiple laboratory abnormalities, such as increased white blood cell counts, elevated C-reactive protein level and urinary glucose, and presence of occult blood in urine. All cases responded well to the treatment with antihistamines and glucocorticoids. The treatment duration ranged from 3 to 10 days, and the outcome was good.Conclusion:TAT-or anti-tetanus immunoglobulin-induced cutaneous delayed-type hypersensitivity may still occur in patients with a negative skin test or after desensitization treatment, and mainly manifests as urticaria-like rashes.