Fisher M M, Baldo B A
University of Sydney, NSW, Australia.
Br J Anaesth. 1998 Jan;80(1):26-9. doi: 10.1093/bja/80.1.26.
Increased concentrations of mast cell tryptase are a highly sensitive indicator of anaphylactic reactions during anaesthesia. We obtained serum specimens from 350 patients after possible anaphylactic reactions during anaesthesia. Serum was collected from patients in our own institution (27), and transported by mail and courier from other hospitals in response to a request in the medical literature (323). Concentrations of mast cell tryptase were measured in 416 specimens. Intradermal testing was performed in 217 patients and radioimmunoassay for drug-specific antibodies with serum in 198 patients. Mast cell tryptase concentrations were increased in 158 patients, equivocal in 10 and not increased in 182. There was a significant difference in the incidence of positive intradermal tests, radioimmunoassay tests and evidence of an IgE-mediated reaction in patients whose mast cell tryptase concentrations were increased. Seven of 143 patients whose mast cell tryptase concentrations were not increased at appropriate sampling times had positive tests for IgE antibodies, and in 33 of 158 patients with increased mast cell tryptase concentrations no IgE antibodies were detected. We conclude that increased mast cell tryptase concentrations are a valuable indicator of an anaphylactic reaction during anaesthesia. Their presence favours an IgE-mediated cause but does not always distinguish between anaphylactoid and anaphylactoid reactions, and patients in whom mast cell tryptase concentrations are not increased still require skin testing.
肥大细胞类胰蛋白酶浓度升高是麻醉期间过敏反应的高度敏感指标。我们收集了350例麻醉期间可能发生过敏反应患者的血清标本。其中27例血清标本来自我们自己的机构，另外323例是应医学文献中的请求通过邮件和快递从其他医院转运而来的。对416份标本检测了肥大细胞类胰蛋白酶浓度。对217例患者进行了皮内试验，对198例患者的血清进行了药物特异性抗体的放射免疫测定。158例患者的肥大细胞类胰蛋白酶浓度升高，10例结果不明确，182例未升高。肥大细胞类胰蛋白酶浓度升高的患者，其皮内试验阳性、放射免疫测定试验阳性及IgE介导反应证据的发生率存在显著差异。143例在适当采样时间肥大细胞类胰蛋白酶浓度未升高的患者中，有7例IgE抗体检测呈阳性；而在158例肥大细胞类胰蛋白酶浓度升高的患者中，有33例未检测到IgE抗体。我们得出结论，肥大细胞类胰蛋白酶浓度升高是麻醉期间过敏反应的重要指标。其存在支持IgE介导的病因，但并不总能区分过敏反应和类过敏反应，肥大细胞类胰蛋白酶浓度未升高的患者仍需进行皮肤试验。
