Scheule A M, Beierlein W, Wendel H P, Jurmann M J, Eckstein F S, Ziemer G
Department of Surgery, Division of Thoracic Surgery, Tübingen University Hospital, Germany.
J Thorac Cardiovasc Surg. 1999 Aug;118(2):348-53. doi: 10.1016/S0022-5223(99)70226-6.
In cardiac operations, aprotinin therapy is used either locally as a component of commercially available fibrin tissue adhesives, intravenously, or combined. Our aim was to examine the formation of aprotinin-specific antibodies with regard to the application mode.
Sera of 150 patients who had undergone cardiac operations and were receiving aprotinin therapy for the first time were sampled before the operation and at medians of 3.5 and 13.3 months after the operation. Aprotinin-specific IgG including all subgroups and aprotinin-specific IgE were analyzed. Aprotinin was given locally (as contained in fibrin sealant; n = 45; median dose, 6000 KIU), intravenously (n = 46; 2.000 x 10(6) KIU), and combined (n = 59; 2.012 x 10(6) KIU).
At 3.5 months, the prevalence of aprotinin-specific IgG antibodies was 33% (15/45 patients) after local, 28% (13/46 patients) after intravenous, and 69% (41/59 patients) after combined exposure (P =.0001). At 13.3 months, the prevalence of aprotinin-specific IgG antibodies was 10% (4/41 patients) after local, 31% (13/42 patients) after intravenous, and 49% (28/57 patients) after combined exposure. Total aprotinin dose was similar in patients who were antibody positive and negative. Before the operation, no aprotinin-specific antibodies were detected. Aprotinin-specific IgE were not found after the operation.
Local aprotinin contact induces a specific immune response and reinforces that of intravenous exposure. The antibody spectrum is identical to the immune response induced by intravenous exposure. Any exposure should be documented. For use in cardiac operations as a hemostyptic, the necessity itself and alternatives for aprotinin as a stabilizing agent merit consideration.
在心脏手术中，抑肽酶治疗可局部作为市售纤维蛋白组织粘合剂的成分使用、静脉注射或联合使用。我们的目的是研究抑肽酶特异性抗体的形成与应用方式的关系。
对150例首次接受心脏手术并接受抑肽酶治疗的患者的血清在手术前以及术后3.5个月和13.3个月的中位数时间点进行采样。分析包括所有亚组的抑肽酶特异性IgG和抑肽酶特异性IgE。抑肽酶局部给药（如纤维蛋白封闭剂中所含；n = 45；中位剂量，6000 KIU）、静脉注射（n = 46；2.000×10⁶ KIU）和联合给药（n = 59；2.012×10⁶ KIU）。
在3.5个月时，局部给药后抑肽酶特异性IgG抗体的患病率为33%（15/45例患者），静脉注射后为28%（13/46例患者），联合暴露后为69%（41/59例患者）（P = 0.0001）。在13.3个月时，局部给药后抑肽酶特异性IgG抗体的患病率为10%（4/41例患者），静脉注射后为31%（13/42例患者），联合暴露后为49%（28/57例患者）。抗体阳性和阴性患者的总抑肽酶剂量相似。手术前未检测到抑肽酶特异性抗体。术后未发现抑肽酶特异性IgE。
局部接触抑肽酶会引发特异性免疫反应，并增强静脉暴露所引发的免疫反应。抗体谱与静脉暴露所引发的免疫反应相同。任何暴露情况均应记录。对于在心脏手术中用作止血剂而言，抑肽酶作为稳定剂本身的必要性及其替代方案值得考虑。
