摘要目的:评估变应性接触性皮炎（allergic contact dermatitis，ACD）患者斑贴试验阳性率、过敏原分布及其与人口学特征、免疫指标的关联。方法:采用病例回顾研究，纳入2023年6月至2024年6月首都医科大学宣武医院402例临床疑诊ACD患者（女性338例，中位年龄38岁；男性64例，中位年龄43岁），行标准斑贴试验（中国基准系列100项半抗原）及血清总IgE、嗜酸性粒细胞（EOS）检测。组间比较采用卡方检验、 t检验/Mann-Whitney U检验，相关性采用Spearman分析。 结果:402例患者斑贴试验总体阳性率为62.69%（252/402），其中85.71%（216/252）对前21种过敏原敏感；患者以女性（84.26%，182/216）和19~35岁组（36.57%，79/216）为主。主要致敏原为氯化钴（总阳性率22.89%，92/402）和硫酸镍（19.90%，80/402），硫柳汞的重度反应比例（+++）最高（10/16）。男性对卡巴混合物（ OR=5.10， P=0.002）和没食子酸辛酯（ OR=2.64， P=0.047）的阳性风险显著高于女性。年龄分层显示：36~50岁组氯化钴阳性率异常升高至76.72%（50/65），显著高于其他年龄组（≤18岁：20.00%；19~35岁：21.51%；>50岁：16.13%；均 P<0.05），而>50岁组硫酸镍阳性率最高（20.96%，13/62）。斑贴试验阳性数量、反应强度（平均/最大）与总IgE（ r=-0.075~0.063）、嗜酸性粒细胞绝对值及百分比均无显著相关性（ P>0.05）。临床诊断中，>50岁组湿疹比例达22.58%（14/62），过敏性皮炎合并ACD最常见（16.67%，36/216）。 结论:硫酸镍与氯化钴为ACD主要致敏原，各年龄组致敏模式相似且与IgE/EOS无关；硫柳汞重度反应比例显著更高，或与含汞制品（如疫苗防腐剂）强致敏性相关；36~50岁组氯化钴阳性率显著升高，提示特殊暴露风险；女性高发或与镍/钴相关制品（饰品、化妆品）接触相关。

abstractsObjective:This study aimed to assess the patch test positivity rate, allergen distribution, and their associations with demographic characteristics and immune indicators in patients with allergic contact dermatitis (ACD).Methods:A retrospective medical record analysis was conducted on 402 patients suspected of ACD (338 females, median age 38 years; 64 males, median age 43 years) seen at Xuanwu Hospital, Capital Medical University between June 2023 and June 2024. Standard patch tests (using 100 haptens from the Chinese baseline series) were administered, and serum total IgE and eosinophil levels were measured. Statistical analyses included chi-square tests, t-tests/Mann-Whitney U tests for group comparisons, and Spearman correlation for associations. Results:The overall patch test positivity rate among the 402 patients was 62.69% (252/402), with 85.71% (216/252) showing sensitivity to the top 21 allergens. Predominantly, the affected individuals were females (84.26%, 182/216) aged 19-35 years (36.57%, 79/216). The primary sensitizers were cobalt chloride (22.89%, 92/402) and nickel sulfate (19.90%, 80/402). The highest proportion of severe reactions (+++) was observed with thimerosal (10/16). Males exhibited significantly higher positive risks for carba mix ( OR=5.10, P=0.002) and octyl gallate ( OR=2.64, P=0.047) compared to females. The age-stratified results revealed that the cobalt chloride positive rate was abnormally increased to 76.72% (50/65) in the 36-50 years age group, a rate significantly higher than those observed in the ≤18 years group (20.00%), the 19-35 years group (21.51%), and the >50 years group (16.13%; all P<0.05). In contrast, the >50 years age group exhibited the highest positive rate for nickel sulfate among all age groups at 20.96% (13/62). No significant correlations were found between the number of positive patch tests, reaction intensity (average/maximum), and total IgE ( r=-0.075-0.063), absolute and percentage of eosinophils ( P>0.05). Clinically, eczema prevalence in the>50 age group was 22.58% (14/62), with ACD complicated by allergic dermatitis being the most common (16.67%, 36/216). Conclusion:Nickel sulfate and cobalt chloride are primary sensitizers for ACD. Sensitization patterns across age groups are similar and unrelated to IgE/EOS levels. The higher incidence of severe reactions to thimerosal may be linked to heightened sensitization to mercury-containing products like vaccine preservatives. The notably increased cobalt chloride positivity in the 36-50 age group suggests a unique exposure risk, while the higher prevalence in females may be associated with contact with nickel/cobalt-containing items such as jewelry and cosmetics.