Weiler J M, Gellhaus M A, Carter J G, Meng R L, Benson P M, Hottel R A, Schillig K B, Vegh A B, Clarke W R
Department of Medicine, University of Iowa, Iowa City.
J Allergy Clin Immunol. 1990 Apr;85(4):713-9. doi: 10.1016/0091-6749(90)90189-b.
Protamine sulfate administration may cause life-threatening reactions. We prospectively examined the incidence of immediate adverse reaction after protamine in 243 patients who underwent cardiopulmonary bypass surgery. Twenty-six patients (10.7%) had reactions, and 1.6% had a precipitous drop in blood pressure immediately after protamine administration. Risk factors were previous exposure to protamine, diabetes, history of receiving protamine-containing insulin, and possibly vasectomy. However, neither a positive skin test nor a positive IgE ELISA for antiprotamine antibody predicted that a patient would have a reaction. C4a levels were increased in patients who had reactions as compared with age-, sex-, and cardiac disease-matched patients who did not have reactions, suggesting a role for complement in some reactions. Immediate adverse reactions to protamine are very common, and alternative therapies are urgently needed to eliminate the use of protamine.
硫酸鱼精蛋白的使用可能会引起危及生命的反应。我们前瞻性地研究了243例接受体外循环手术患者使用鱼精蛋白后立即出现不良反应的发生率。26例患者（10.7%）出现反应，1.6%在使用鱼精蛋白后立即出现血压急剧下降。危险因素包括既往接触过鱼精蛋白、糖尿病、接受含鱼精蛋白胰岛素治疗史以及可能的输精管切除术。然而，抗鱼精蛋白抗体的皮肤试验阳性或IgE ELISA阳性均不能预测患者会出现反应。与年龄、性别和心脏病匹配的未出现反应的患者相比，出现反应的患者C4a水平升高，提示补体在某些反应中起作用。鱼精蛋白的立即不良反应非常常见，迫切需要替代疗法以避免使用鱼精蛋白。
