Friedman B S, Steinberg S C, Meggs W J, Kaliner M A, Frieri M, Metcalfe D D
Mast Cell Physiology Section, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland 20892.
Am J Med. 1989 Dec;87(6):649-54. doi: 10.1016/s0002-9343(89)80398-5.
The use of plasma histamine determinations as a screening tool to distinguish patients with recurrent unexplained anaphylaxis, flushing, or both from those with mastocytosis has never been evaluated. This retrospective study was designed to determine if plasma histamine levels can be used as a screening test.
Values of plasma histamine levels, measured using a sensitive radioenzymatic assay, from 41 patients with mastocytosis, 26 patients with recurrent unexplained anaphylaxis, and 76 normal subjects were statistically analyzed to determine diagnostic usefulness and accuracy. Patients with mastocytosis were subdivided into four smaller groups on the basis of clinical and histopathologic findings: (1) isolated urticaria pigmentosa, (2) indolent systemic mastocytosis, (3) mastocytosis with dysmyelopoiesis, and (4) lymphadenopathic mastocytosis with eosinophilia.
The distribution of plasma histamine values among patients with unexplained anaphylaxis strongly resembled that among the normal subjects (p greater than 0.50, Smirnov test), whereas patients with mastocytosis tended to show moderate to marked elevations above the upper limit of normal (617 pg/mL). The geometric mean plasma histamine levels in mastocytosis subgroups 2, 3, and 4 were found to be quite similar (1,085, 1,976, and 1,433 pg/mL; p greater than 0.50, F-test); moreover, each mean level was significantly greater than those of the normal subjects and of patients with unexplained anaphylaxis (p less than 0.01, Scheffé multiple comparison test). Analysis of the 27 sets of plasma histamine values collected on patients with indolent systemic mastocytosis revealed that the earliest value observed fell below 617 pg/mL in eight patients (30%). A similar analysis applied to the two earlier values indicated that both values would fall below 617 pg/mL in 9% of the patients. Data in four patients with mastocytosis demonstrated a diurnal variation in plasma histamine, with the highest values observed in the early morning (approximately 2:00 A.M.) and the lowest values in the afternoon (approximately 2:00 P.M.).
We conclude that, on average, patients with mastocytosis have elevated plasma histamine levels, whereas patients with unexplained anaphylaxis have plasma histamine levels within the normal range during asymptomatic periods; that plasma histamine levels in patients with mastocytosis exhibit a diurnal variation; and that plasma histamine determinations alone are not useful to screen patients for mastocytosis.
血浆组胺测定作为一种筛查工具，用于区分复发性不明原因过敏反应、潮红或两者兼具的患者与肥大细胞增多症患者，这一用途从未得到评估。本回顾性研究旨在确定血浆组胺水平是否可作为一种筛查试验。
采用灵敏的放射酶法测定41例肥大细胞增多症患者、26例复发性不明原因过敏反应患者及76名正常受试者的血浆组胺水平值，并进行统计学分析，以确定其诊断效用和准确性。根据临床和组织病理学发现，将肥大细胞增多症患者分为四个较小的组：（1）孤立性色素性荨麻疹，（2）惰性全身性肥大细胞增多症，（3）伴有骨髓生成异常的肥大细胞增多症，（4）伴有嗜酸性粒细胞增多的淋巴结病性肥大细胞增多症。
不明原因过敏反应患者的血浆组胺值分布与正常受试者的分布非常相似（斯米尔诺夫检验，p>0.50），而肥大细胞增多症患者的血浆组胺值往往高于正常上限（617 pg/mL），呈中度至显著升高。发现肥大细胞增多症亚组2、3和4的血浆组胺几何平均水平相当相似（分别为1085、1976和1433 pg/mL；F检验，p>0.50）；此外，每个平均水平均显著高于正常受试者和不明原因过敏反应患者的水平（谢费多重比较检验，p<0.01）。对惰性全身性肥大细胞增多症患者收集的27组血浆组胺值进行分析发现，8例患者（30%）观察到的最早值低于617 pg/mL。对两个较早值进行类似分析表明，9%的患者这两个值均低于617 pg/mL。4例肥大细胞增多症患者的数据显示血浆组胺存在日变化，清晨（约凌晨2:00）观察到的值最高，下午（约下午2:00）的值最低。
我们得出结论，平均而言，肥大细胞增多症患者的血浆组胺水平升高，而不明原因过敏反应患者在无症状期的血浆组胺水平在正常范围内；肥大细胞增多症患者的血浆组胺水平呈现日变化；仅血浆组胺测定对筛查肥大细胞增多症患者并无用处。
