Ellerhorst J A, Comstock J P, Nell L J
Department of Medicine, Baylor College of Medicine, Houston, Texas 77030.
Am J Med Sci. 1990 May;299(5):298-301. doi: 10.1097/00000441-199005000-00002.
Treatment with neutral protamine Hagedorn (NPH) insulin predisposes individuals with diabetes to anaphylactoid reactions when given bolus protamine for heparin reversal during cardiovascular procedures. To prospectively examine production of protamine antibodies, 30 patients with non-insulin dependent diabetes were followed for 12 months from initiation of therapy with porcine NPH or Lente insulin. Twenty-one subjects were randomly assigned to NPH (protamine containing) and nine controls to Lente (protamine free) insulin. Protamine specific IgG antibody was produced by 6/21 (29%) of NPH-treated subjects and 0/9 controls. Among NPH treated subjects, there was no difference between protamine antibody producers and non-producers with regard to age, race, weight, or pre-treatment glycosylated hemoglobin. Both producer and non-producer groups received similar amounts of insulin and protamine and achieved similar glycemic control. Insulin antibodies were made by 4/6 (67%) of protamine antibody producers and by 6/15 (40%) of non-producers (NS). The authors conclude that one of three new diabetics who are treated with porcine NPH insulin will make IgG protamine antibodies. These antibodies do not affect insulin requirements, glycemic control, or insulin antibody production. Because of the frequency of protamine antibody production and the risk of anaphylaxis to bolus protamine administration in NPH treated diabetics, the authors suggest that NPH insulin-treated individuals should avoid heparin reversal by protamine.
在心血管手术期间，使用中性鱼精蛋白锌（NPH）胰岛素治疗的糖尿病患者在静脉注射鱼精蛋白以逆转肝素作用时，易发生类过敏反应。为了前瞻性地检测鱼精蛋白抗体的产生情况，对30例非胰岛素依赖型糖尿病患者从开始使用猪NPH胰岛素或慢胰岛素治疗起随访12个月。21名受试者被随机分配至NPH（含鱼精蛋白）组，9名对照组受试者被分配至慢胰岛素（不含鱼精蛋白）组。接受NPH治疗的受试者中有6/21（29%）产生了鱼精蛋白特异性IgG抗体，而对照组9名受试者中无一人产生。在接受NPH治疗的受试者中，产生鱼精蛋白抗体者与未产生者在年龄、种族、体重或治疗前糖化血红蛋白方面无差异。产生抗体组和未产生抗体组接受的胰岛素和鱼精蛋白量相似，血糖控制情况也相似。产生鱼精蛋白抗体者中有4/6（67%）产生了胰岛素抗体，未产生鱼精蛋白抗体者中有6/15（40%）产生了胰岛素抗体（无显著性差异）。作者得出结论，使用猪NPH胰岛素治疗的新诊断糖尿病患者中，三人中有一人会产生IgG鱼精蛋白抗体。这些抗体不影响胰岛素需求量、血糖控制或胰岛素抗体的产生。鉴于接受NPH治疗的糖尿病患者中鱼精蛋白抗体产生的频率以及静脉注射鱼精蛋白引发过敏反应的风险，作者建议接受NPH胰岛素治疗的患者应避免使用鱼精蛋白逆转肝素作用。
