Tse R, Wong C X, Kesha K, Garland J, Tran Y, Anne S, Elstub H, Cala A D, Palmiere C, Patchett K L
Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand.
Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Australia.
Forensic Sci Int. 2018 Mar;284:5-8. doi: 10.1016/j.forsciint.2017.12.035. Epub 2017 Dec 28.
Serum mast cell tryptase is used to support the diagnosis of anaphylaxis. The recommended clinical cut-off for total tryptase (<11.4μg/L) appears unsuitable in the post mortem setting due to largely unknown processes which result in significantly elevated levels in these samples. Consequently there is no widely accepted tryptase cut-off level for diagnosing an anaphylactic death. This 5-year retrospective study compared total tryptase levels in post mortem femoral blood in anaphylactic deaths and control. Univariate and multivariate analysis was used to assess the relative contribution of other factors (age, gender, post mortem interval, and presence of resuscitation) on post mortem tryptase levels. Nine anaphylactic deaths and 45 controls were identified. Receiver-operating characteristic (ROC) curve analysis identified an optimal cut-off of 53.8μg/L, with sensitivity of 89%, and specificity of 93%, for total post mortem tryptase in femoral blood to diagnosis anaphylaxis. No other factors showed any statistical significant contribution to post mortem tryptase elevation. Femoral total post mortem tryptase level of 53.8μg/L and above is a useful ancillary test in diagnosing an anaphylactic death.
血清肥大细胞类胰蛋白酶用于辅助诊断过敏反应。由于导致这些样本中类胰蛋白酶水平显著升高的过程在很大程度上未知，推荐的总类胰蛋白酶临床临界值（<11.4μg/L）在尸检情况下似乎并不适用。因此，目前尚无广泛接受的用于诊断过敏性死亡的类胰蛋白酶临界值水平。这项为期5年的回顾性研究比较了过敏性死亡病例和对照组尸检股静脉血中的总类胰蛋白酶水平。采用单因素和多因素分析评估其他因素（年龄、性别、尸检间隔时间和复苏情况）对尸检类胰蛋白酶水平的相对影响。共确定了9例过敏性死亡病例和45例对照。受试者工作特征（ROC）曲线分析确定，股静脉血中用于诊断过敏反应的尸检总类胰蛋白酶的最佳临界值为53.8μg/L，敏感性为89%，特异性为93%。没有其他因素对尸检类胰蛋白酶升高显示出任何统计学上的显著影响。股静脉血尸检总类胰蛋白酶水平达到或高于53.8μg/L是诊断过敏性死亡的一项有用的辅助检查。
