Savolainen H
Institute of Occupational Health Sciences, Lausanne.
Schweiz Med Wochenschr. 1999 Mar 27;129(12):465-7.
The pathophysiological mechanisms of organic diisocyanate-induced respiratory disease remain largely unknown. Some 20% of patients have specific antibodies towards diisocyanate monomers whereas even in this circumstance their presence does not correlate very well with results in clinical provocation tests. The formation of diisocyanate haptens is the trigger for the immunological reactions. However, it is known that the reactions with protein and other macromolecules may be slow and hydrolysis of the isocyanate moities to corresponding amines as catalyzed by bicarbonate is more rapid. The liberated amines, or their intermediates, probably have an important role in the activation of tissue thromboplastin activator, loss of serum antitrypsin activity, and, finally, in neurogenic inflammation. Hypothetically, susceptible individuals probably include those which are slow acetylators of exogenous amines and carries of heterozygous antitrypsin phenotypes.
有机二异氰酸酯诱发的呼吸道疾病的病理生理机制在很大程度上仍不清楚。约20%的患者对二异氰酸酯单体有特异性抗体，然而即便在这种情况下，抗体的存在与临床激发试验结果的相关性也不是很好。二异氰酸酯半抗原的形成是免疫反应的触发因素。然而，已知其与蛋白质和其他大分子的反应可能较慢，而异氰酸酯基团在碳酸氢盐催化下向相应胺类的水解则更快。释放出的胺类或其中间体可能在组织凝血活酶激活物的活化、血清抗胰蛋白酶活性丧失以及最终在神经源性炎症中起重要作用。据推测，易感个体可能包括那些对外源胺类乙酰化速度较慢的个体以及携带杂合抗胰蛋白酶表型的个体。
