2010-2021 年美国多中心围手术期过敏反应回顾性报告。
A US-Based Multicenter Retrospective Report of Perioperative Anaphylaxis, 2010-2021.
机构信息
Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Fla.
Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Fla.
出版信息
J Allergy Clin Immunol Pract. 2024 Jun;12(6):1594-1602.e9. doi: 10.1016/j.jaip.2024.02.042. Epub 2024 Apr 3.
BACKGROUND
US-based perioperative anaphylaxis (POA) studies are limited to single-center experiences. A recent report found that a serum acute tryptase (sAT) >9.8 ng/mL or mast cell activation (MCA) can predict POA causal agent identification. Urinary mast cell mediator metabolites (uMC) have not been studied in POA.
OBJECTIVE
To analyze the epidemiologic data of POA, to determine if sAT or MCA can predict suspected causal agent identification, and to evaluate uMC utility in POA.
METHODS
This study is a retrospective multicenter review of POA cases that were subcategorized by suspected causal agent identification status. sAT, MCA (defined as sAT >2 + 1.2 × serum baseline tryptase), and uMC (N-methylhistamine [N-MH], 11β-prostaglandin-F [11β-PGF], leukotriene E [LTE]) were recorded.
RESULTS
Of 100 patients (mean age 52 [standard deviation 17] years, 94% adult, 50% female, 90% White, and 2% Hispanic) with POA, 73% had an sAT available, 41% had MCA, 16% had uMC available, and 50% had an identifiable suspected cause. POA cases with an identifiable suspected cause had a positive MCA status (100% vs 78%; P = .01) compared with POA with an unidentifiable cause. An elevated median sAT did not predict causal agent identification. Positive uMC were not associated with suspected causal agent identification during POA. Patients with positive uMC had a higher median sAT (30 vs 6.45 ng/mL; P = .001) and MCA status (96% vs 12%; P = .001) compared with negative uMC patients. Patients with POA had an elevated acute/baseline uMC ratios: 11β-PGF ratio > 1.6, N-MH ratio >1.7, and LTE ratio >1.8.
CONCLUSIONS
The presence of MCA in POA is associated with suspected causal agent identification. Positive uMC possibly correlate with a higher sAT level and MCA status but require further study. The authors suggest applying an acute/baseline uMC ratio (11β-PGF ratio >1.6, N-MH ratio >1.7, and LTE ratio >1.87) in patients with POA for MCA when a tryptase level is inconclusive during POA evaluations.
背景
美国围手术期过敏反应（POA）研究仅限于单中心经验。最近的一份报告发现，血清急性胰蛋白酶（sAT）>9.8ng/mL 或肥大细胞激活（MCA）可预测 POA 病因鉴定。尿肥大细胞介质代谢产物（uMC）尚未在 POA 中进行研究。
目的
分析 POA 的流行病学数据，确定 sAT 或 MCA 是否可以预测可疑病因鉴定，并评估 uMC 在 POA 中的效用。
方法
本研究是对 POA 病例的回顾性多中心回顾，这些病例根据可疑病因鉴定状态进行了分类。记录 sAT、MCA（定义为 sAT>2+1.2×血清基线胰蛋白酶）和 uMC（N-甲基组氨酸[N-MH]、11β-前列腺素-F[11β-PGF]、白三烯 E[LTE]）。
结果
在 100 例 POA 患者（平均年龄 52[标准差 17]岁，94%为成人，50%为女性，90%为白人，2%为西班牙裔）中，73%有 sAT 可用，41%有 MCA，16%有 uMC 可用，50%有可识别的可疑病因。与无明确病因的 POA 相比，有明确可疑病因的 POA 病例 MCA 状态呈阳性（100% vs 78%；P=.01）。升高的中位 sAT 并不预测病因鉴定。阳性 uMC 与 POA 期间可疑病因鉴定无关。阳性 uMC 患者的中位 sAT（30 与 6.45ng/mL；P=.001）和 MCA 状态（96%与 12%；P=.001）高于阴性 uMC 患者。POA 患者的急性/基础 uMC 比值升高：11β-PGF 比值>1.6，N-MH 比值>1.7，LTE 比值>1.8。
结论
POA 中 MCA 的存在与可疑病因鉴定相关。阳性 uMC 可能与更高的 sAT 水平和 MCA 状态相关，但需要进一步研究。作者建议在 POA 评估期间，当 sAT 水平不确定时，在 POA 患者中应用急性/基础 uMC 比值（11β-PGF 比值>1.6，N-MH 比值>1.7，LTE 比值>1.87）进行 MCA。
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