Saitoh J, Mitsuhata H, Horiguchi Y, Saitoh K, Fukuda H, Shimizu R
Department of Anesthesiology, Jichi Medical School, Tochigi.
Masui. 1995 Sep;44(9):1265-8.
We described a case of anaphylaxis diagnosed by the evaluation of plasma mast cell tryptase and a case of anaphylactoid reaction. In a patient undergoing pulmonary lobectomy, anaphylaxis, showing the elevation of plasma tryptase, was provoked by physiological glue for hemostasis during the operation. During the operation, cardiovascular collapse occurred suddenly, at which time the cause was not diagnosed. After completion of the operation and removal of drapes, diffuse urticaria with wide erythema on the torso and the upper extremity was noticed. Suspecting allergic adverse reaction, plasma tryptase was measured 2h and 5h after the start of the episode, showing 34.6 ng.ml-1 at 2h and 15.3 at 5h. Because these elevations of plasma tryptase indicated degranulation of mast cells, evaluation of the causative drugs was performed 7 weeks after the episode. Physiological glue was confirmed to be causative drug. In another patient for total hysterectomy and bilateral oophorectomy, adverse reaction occurred after completion of the operation and extubation. Increase in plasma histamine concentration to 4.94 ng.ml-1 that could induce systemic reaction was noticed; however, concentrations of plasma tryptase 25 min, 3h and 7h after the episode were not elevated. This finding indicated that the adverse reaction was not based on degranulation of mast cell, and was anaphylactoid reaction provoked by nonspecific histamine-release. In conclusion, measurement of plasma tryptase is a useful method for differential diagnosis of anaphylaxis and anaphylactoid reaction.
我们描述了一例通过评估血浆肥大细胞类胰蛋白酶诊断的过敏反应病例和一例类过敏反应病例。在一名接受肺叶切除术的患者中，手术期间用于止血的生物胶引发了过敏反应，表现为血浆类胰蛋白酶升高。手术过程中，突然发生心血管虚脱，当时病因未明确诊断。手术结束并移除手术单后，发现躯干和上肢出现弥漫性荨麻疹伴广泛红斑。怀疑是过敏不良反应，在发作开始后2小时和5小时测量血浆类胰蛋白酶，2小时时为34.6 ng/ml，5小时时为15.3 ng/ml。由于这些血浆类胰蛋白酶的升高表明肥大细胞脱颗粒，在发作7周后对致病药物进行了评估。确认生物胶是致病药物。在另一名接受全子宫切除术和双侧卵巢切除术的患者中，手术后拔管时出现不良反应。发现血浆组胺浓度增加至4.94 ng/ml，可引发全身反应；然而，发作后25分钟、3小时和7小时的血浆类胰蛋白酶浓度未升高。这一发现表明该不良反应并非基于肥大细胞脱颗粒，而是由非特异性组胺释放引发的类过敏反应。总之，血浆类胰蛋白酶的测定是鉴别过敏反应和类过敏反应的有用方法。
