Pfannschmidt J, Steeg D, Jugert F
Department of Cardiac Surgery, University of Cologne, Germany.
Curr Med Res Opin. 1995;13(5):282-4. doi: 10.1185/03007999509111553.
High-dose aprotinin is now routinely used in cardiac surgery to reduce postoperative blood loss and transfusion requirements, although several cases of anaphylactic reactions to the proteinase inhibitor have been reported. As part of a multi-centre study to evaluate the immunological response to aprotinin after first exposure 61 cardiac surgical patients were treated with the Hammersmith regimen. Patients with previous aprotinin exposure were excluded from the study. To determine specific IgG and IgE antibodies blood samples were taken pre-operatively, within 3 to 4 weeks and 6 to 7 months after operation. Determinations were made by using Western Blot and ELISA methods. Fifty-six patients were followed up for a 6-month period, 26 (46.4%) of them developed IgG antibodies to aprotinin determined by Western Blot, whereas only 14 (26.8%) patients with IgG antibodies were found by the ELISA. IgE antibodies were not found in any of the patients. On hospital admission and 6 months post-operatively additional intradermal prick tests were performed. No clear-cut positive reaction to the skin test was found in any patient.
高剂量抑肽酶目前在心脏手术中常规使用，以减少术后失血和输血需求，尽管已有数例对这种蛋白酶抑制剂发生过敏反应的报道。作为一项评估首次接触抑肽酶后免疫反应的多中心研究的一部分，61例心脏手术患者接受了哈默史密斯方案治疗。曾接触过抑肽酶的患者被排除在研究之外。为了测定特异性IgG和IgE抗体，在术前、术后3至4周以及6至7个月采集血样。采用蛋白质印迹法和酶联免疫吸附测定法进行检测。56例患者接受了为期6个月的随访，其中26例（46.4%）通过蛋白质印迹法检测出对抑肽酶产生IgG抗体，而通过酶联免疫吸附测定法仅发现14例（26.8%）有IgG抗体的患者。所有患者均未检测到IgE抗体。在入院时和术后6个月进行了额外的皮内点刺试验。未发现任何患者对皮肤试验有明确的阳性反应。
