TRYPTASE LEVELS AS AN INDICATOR OF MAST-CELL ACTIVATION IN SYSTEMIC-ANAPHYLAXIS AND MASTOCYTOSIS
TRYPTASE LEVELS AS AN INDICATOR OF MAST-CELL ACTIVATION IN SYSTEMIC-ANAPHYLAXIS AND MASTOCYTOSIS
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DOI：
10.1056/nejm198706253162603
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发表时间：
1987-06-25
影响因子：
158.5
通讯作者：
SULLIVAN, T
中科院分区：
文献类型：
--
作者：
SCHWARTZ, LB;METCALFE, DD;SULLIVAN, T
需要更好的方法来评估体内肥大细胞的活化，并区分肥大细胞的活化和嗜碱性粒细胞的活化。类胰蛋白酶是一种中性蛋白酶，选择性地集中在人肥大细胞（而不是嗜碱性粒细胞）的分泌颗粒中，由肥大细胞与组胺一起释放，并作为肥大细胞活化的标志物。17例系统性肥大细胞增多症患者血浆类胰蛋白酶浓度与组胺浓度呈直线相关（P < 0.01）。17名患者中有11名的类胰蛋白酶水平为4至88 ng/ml，表明肥大细胞正在活化。6名患者在服用青霉素、阿司匹林、甜瓜、黄蜂蜇伤、运动或注射抗淋巴细胞球蛋白后出现相应的过敏反应，血清类胰蛋白酶水平范围为9 ~ 75 ng/ml，表明在这些事件中肥大细胞活化。相比之下，血清类胰蛋白酶水平低于5 ng/ml，在所有患者表现为心肌疾病（n = 8，6与低血压）或败血症（n = 6，3与低血压）和对照组（n = 20）。一名患者在黄蜂叮咬引起过敏反应后发生心肌梗死，类胰蛋白酶水平升高至25 ng/ml。因此，血浆或血清类胰蛋白酶水平是肥大细胞相关事件的诊断相关性。
Better methods are needed to assess mast-cell activation in vivo and to distinguish the activation of mast cells from that of basophils. Tryptase, a neutral protease selectively concentrated in the secretory granules of human mast cells (but not basophils), is released by mast cells together with histamine and serves as a marker of mast-cell activation. In 17 patients with systemic mastocytosis, concentrations of tryptase in plasma were linearly related to those of histamine (P < 0.01). Eleven of the 17 patients had tryptase levels of 4 to 88 ng per milliter, indicating ongoing mast-cell activation. In each of six patients who experienced corresponding anaphylactic reactions after penicillin, aspirin, or melon ingestion, a wasp sting, exercise, or antilymphocyte globulin injection, tryptase levels in serum ranged from 9 to 75 ng per milliliter, indicating mast-cell activation during each of these events. In contrast, serum tryptase levels were less than 5 ng per milliliter in all patients presenting with myocardial disease (n = 8, 6 with hypotension) or sepsis (n = 6, 3 with hypotension) and in the controls (n = 20). One patient had a myocardial infarction after anaphylaxis in response to a wasp sting and an elevated tryptase level of 25 ng per milliliter. Thus, the plasma or serum tryptase level is a diagnostic correlate of mast-cell-related events.