Koga N, Nagano T, Sato T, Kagasawa K
Department of Artificial Organs, Koga Hospital, Kurume City, Japan.
ASAIO J. 1993 Jul-Sep;39(3):M288-91.
An anaphylactoid reaction was observed in a patient treated with low density lipoprotein (LDL) apheresis using a dextran sulfate cellulose (DSC) column and administration of an angiotensin converting enzyme (ACE) inhibitor. The authors have investigated to determine the causes and countermeasures. When using heparin as the anticoagulant, large increases in bradykinin levels in plasma were observed after its passage through the column during the procedure. Increase in bradykinin levels in blood were observed, to a lesser but still significant degree, after terminating the procedure. When withholding the ACE inhibitor for a few days before LDL-apheresis, the increase in bradykinin levels was much weakened and the anaphylactoid reactions became mild. Such anaphylactoid reactions were not observed when the ACE inhibitor was withheld for a few weeks, or when using Futhan instead of heparin as the anticoagulant. Although the critical level of bradykinin needed to cause the anaphylactoid reaction and the other possible causal factors remained unclear, the bradykinin levels are thought to be related to the reactions.
在一名使用硫酸葡聚糖纤维素（DSC）柱进行低密度脂蛋白（LDL）单采并给予血管紧张素转换酶（ACE）抑制剂治疗的患者中观察到类过敏反应。作者进行了调查以确定其原因和应对措施。当使用肝素作为抗凝剂时，在操作过程中血浆通过该柱后，观察到缓激肽水平大幅升高。在操作结束后，血液中缓激肽水平也有升高，程度较轻但仍显著。在进行LDL单采前几天停用ACE抑制剂时，缓激肽水平的升高会大大减弱，类过敏反应也会减轻。当停用ACE抑制剂几周，或者使用氟他胺代替肝素作为抗凝剂时，未观察到此类类过敏反应。尽管引发类过敏反应所需的缓激肽临界水平以及其他可能的因果因素仍不清楚，但缓激肽水平被认为与这些反应有关。
