Almutairi Abduarahman, Zaman Fatima, Day-Lewis Megan, Tsitsikov Erdyni, Reiter Amanda, Xue Kanyun, Geha Raif S, Chou Janet, Yee Christina S K
Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Boston Children's Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3543-3548. doi: 10.1016/j.jaip.2020.07.012. Epub 2020 Jul 21.
Chronic granulomatous disease is a primary immunodeficiency characterized by recurrent bacterial and fungal infections, granuloma formation, and inflammatory disease. Impaired neutrophil oxidative function is an essential diagnostic criterion. In vitro exposure of neutrophils to acetaminophen, a commonly used over-the-counter medication, has been associated with reduced neutrophil oxidative function. The clinical implications of acetaminophen intake for dihydrorhodamine (DHR) testing remain unknown.
To evaluate the effect of in vivo administration of therapeutic doses of acetaminophen on DHR diagnostic testing.
We performed DHR testing in 15 healthy adults before and after administering a single dose of acetaminophen. We retrospectively reviewed 195 DHR test results from hospitalized patients who had received acetaminophen, nonsteroidal anti-inflammatory drug, or corticosteroid before testing.
DHR testing result was abnormal in 100% (n = 15) of healthy adults 2 hours after acetaminophen intake. We identified 195 instances of DHR testing less than or equal to 72 hours after acetaminophen ingestion in hospitalized patients who did not have chronic granulomatous disease. DHR results were abnormal in 43 of 195 cases (22.1%). Frequency of false-positive testing was increased in patients who received acetaminophen within 24 hours of testing, and in patients who received more than 1 dose of acetaminophen. Nonsteroidal anti-inflammatory drug and corticosteroid intakes were not associated with abnormal DHR result.
Patients treated with acetaminophen have decreased neutrophil oxidative burst as measured by DHR testing. To avoid falsely abnormal testing for chronic granulomatous disease, patients should be advised to avoid acetaminophen for at least 24 hours before DHR testing.
慢性肉芽肿病是一种原发性免疫缺陷病，其特征为反复发生细菌和真菌感染、肉芽肿形成以及炎症性疾病。中性粒细胞氧化功能受损是一项重要的诊断标准。中性粒细胞在体外暴露于对乙酰氨基酚（一种常用的非处方药物）与中性粒细胞氧化功能降低有关。服用对乙酰氨基酚对二氢罗丹明（DHR）检测的临床影响尚不清楚。
评估治疗剂量的对乙酰氨基酚体内给药对DHR诊断检测的影响。
我们在15名健康成年人单次服用对乙酰氨基酚前后进行了DHR检测。我们回顾性分析了195例住院患者在检测前服用过对乙酰氨基酚、非甾体抗炎药或皮质类固醇的DHR检测结果。
对乙酰氨基酚摄入后2小时，100%（n = 15）的健康成年人DHR检测结果异常。我们在没有慢性肉芽肿病的住院患者中确定了195例在摄入对乙酰氨基酚后72小时内进行的DHR检测。195例中有43例（22.1%）DHR结果异常。在检测前24小时内服用对乙酰氨基酚的患者以及服用超过1剂对乙酰氨基酚的患者中，假阳性检测的频率增加。服用非甾体抗炎药和皮质类固醇与DHR结果异常无关。
通过DHR检测发现，服用对乙酰氨基酚的患者中性粒细胞氧化爆发降低。为避免慢性肉芽肿病检测出现假异常结果，应建议患者在DHR检测前至少24小时避免服用对乙酰氨基酚。
