Littorin M, Truedsson L, Welinder H, Skarping G, Mårtensson U, Sjöholm A G
Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden.
Scand J Work Environ Health. 1994 Jun;20(3):216-22. doi: 10.5271/sjweh.1405.
A case is described of complex reactions associated with exposure to diphenylmethane diisocyanate (MDI), with some immunologic observations.
Medical history, clinical examinations, and analyses of immunologic parameters and the 4,4'-MDI-related amine 4,4'-diaminodiphenylmethane (MDA) in hydrolyzed serum and urine were used.
The patient, a mechanic whose medical history suggested repeated attacks of a work-related pulmonary or systemic disease, was examined because of acute respiratory disorder, rhinoconjunctivitis, and a late systemic reaction after exposure to polyurethane pyrolysis products, including 4,4'-MDI (air level 15 micrograms.m3). Spirometry showed a partly reversible obstructive dysfunction, and a skin-prick test was positive versus isocyanates conjugated with human serum albumin (HSA). MDA was detected in hydrolyzed serum (5.6 ng.ml) and urine (1.6 micrograms.g creatinine-1). In serum, there were specific immunoglobulin (Ig) G (IgG1 and IgG4) and IgE antibodies to 4,4'-MDI-HSA and other isocyanates (phenylisocyanate, toluene diisocyanate, p-toluene monoisocyanate, hexamethylene diisocyanate) conjugated with HSA, a very high total IgE, a raised total IgG, and moderate neutrophilia and eosinophilia. The specific antibodies declined, but were still increased five years later. Furthermore, the values of circulating immune complexes were high. In vitro, the circulating immune complexes in serum increased after the addition of 4,4'-MDI-HSA. The patient had anti-Clq antibodies, which probably accounted for part of the circulating immune complexes.
The reactions associated with MDI exposure (in combination with exposure to pyrolysis products) had features compatible with immediate hypersensitivity and with a complement-mediated immune-complex reaction.
描述一例与接触二苯基甲烷二异氰酸酯（MDI）相关的复杂反应，并进行一些免疫学观察。
采用病史采集、临床检查、免疫参数分析以及对水解血清和尿液中与4,4'-MDI相关的胺4,4'-二氨基二苯基甲烷（MDA）的检测。
该患者为一名机械师，病史提示反复出现与工作相关的肺部或全身性疾病发作。因接触聚氨酯热解产物（包括4,4'-MDI，空气中含量为15微克·立方米）后出现急性呼吸紊乱、鼻结膜炎和迟发性全身反应而接受检查。肺功能检查显示部分可逆性阻塞性功能障碍，皮肤点刺试验对与人血清白蛋白（HSA）偶联的异氰酸酯呈阳性。在水解血清（5.6纳克/毫升）和尿液（1.6微克/克肌酐）中检测到MDA。血清中存在针对与HSA偶联的4,4'-MDI-HSA和其他异氰酸酯（苯基异氰酸酯、甲苯二异氰酸酯、对甲苯单异氰酸酯、六亚甲基二异氰酸酯）的特异性免疫球蛋白（Ig）G（IgG1和IgG4）和IgE抗体，总IgE非常高，总IgG升高，中性粒细胞和嗜酸性粒细胞中度增多。特异性抗体有所下降，但五年后仍升高。此外，循环免疫复合物的值较高。体外实验中，加入4,4'-MDI-HSA后血清中的循环免疫复合物增加。患者有抗Clq抗体，这可能是循环免疫复合物的一部分原因。
与MDI接触（与热解产物接触相结合）相关的反应具有与速发型超敏反应以及补体介导的免疫复合物反应相符的特征。
