Anaphylactic reactions to aprotinin reexposure in cardiac surgery -: Relation to antiaprotinin immunoglobulin G and E antibodies
Anaphylactic reactions to aprotinin reexposure in cardiac surgery -: Relation to antiaprotinin immunoglobulin G and E antibodies
复制标题
DOI：
10.1097/00000542-200107000-00015
复制
发表时间：
2001-07-01
期刊：
影响因子：
8.8
通讯作者：
Mayer, G
中科院分区：
文献类型：
--
作者：
Dietrich, W;Späth, P;Mayer, G
背景：抑肽酶是一种丝氨酸蛋白酶抑制剂，可减少心脏手术中的出血。由于抑肽酶来源于牛肺，因此具有抗原特性。本调查研究过敏反应的发生率在患者再暴露于抑肽酶和预形成的抗抑肽酶免疫球蛋白（IG）G和IgE antibodies.Methods的关系：这项前瞻性观察研究进行了5个中心在德国评估患者重复心脏手术再暴露于抑肽酶之间的1995年和1996年。术前和术后分别使用非商业酶联免疫吸附试验和免疫荧光试验进行抗抑肽酶IgG和IgE抗体测量。过敏性反应定义为在抑肽酶给药10分钟内收缩压20%或更高、心率20%或更高、吸气压大于5 cm H2O或皮肤反应较基线发生重大变化。在121例病例（71例成人，46例儿童）中，观察到抑肽酶平均再暴露间隔为1，654天（范围，16- 7，136天）。术前分别有18例和9例患者检测到抗抑肽酶IgG（光密度比> 3）和IgE抗体（放射性过敏吸附试验[RAST]评分< 3）。在5名患者中检测到高浓度的每种抗体（IgG，光密度比> 10; IgE，RAST评分大于或等于3）。3例患者（2.5%; 95%置信区间，0.51-7.1%）在抑肽酶暴露后发生过敏反应，随后完全恢复;这些患者的再暴露间隔时间小于6个月（22、25和25天），术前IgG浓度为所有患者的最高值（P < 0.05）。试验灵敏度为100%，因为IgG阴性患者中未发生过敏反应（95%置信区间，0.0-3.1%）;试验特异性为98%。术前IgE测量可定量在两个三个反应患者和三个nonreacting patients.Conclusions：定量检测抗抑肽酶IgE和IgG缺乏特异性的预测目的，但是，定量的抗抑肽酶IgE可能会发现患者的风险发展过敏反应抑肽酶再暴露。
Background: Aprotinin, a serine proteinase inhibitor, reduces bleeding during cardiac surgery. As aprotinin is derived from bovine lung, it has antigenic properties. This investigation examined the incidence of anaphylactic reactions in patients reexposed to aprotinin and the relation to preformed antiaprotinin immunoglobulin (Ig)G and IgE antibodies.Methods: This prospective observational study conducted at five centers in Germany evaluated patients undergoing repeat cardiac surgery reexposed to aprotinin between 1995 and 1996. Antiaprotinin IgG and IgE antibody measurements, using a noncommercial enzyme-linked immunosorbent assay and an inmunofluorescence assay, respectively, were performed preoperatively and postoperatively. An anaphylactic reaction was defined as major changes from baseline within 10 min of aprotinin administration of systolic pressure 20% or greater, heart rate 20% or greater, inspiratory pressure greater than 5 cm H2O, or a skin reaction.Results: In 121 cases (71 adults, 46 children), a mean aprotinin reexposure interval of 1,654 days (range, 16-7,136 days) was observed. Preoperative antiaprotinin IgG (optical density ratio > 3) and IgE antibodies (radioallergosorbent test [RAST] score < 3) were detected in 18 and 9 patients, respectively. High concentrations of each (IgG, optical density ratio > 10; IgE, RAST score greater than or equal to 3) were detected in five patients. Three patients (2.5%; 95% confidence interval, 0.51-7.1%) experienced an anaphylactic reaction after aprotinin exposure, followed by full recovery; these patients had reexposure intervals less than 6 months (22, 25, and 25 days) and the highest preoperative IgG concentrations of all patients (P < 0.05). Assay sensitivity was 100%, as no anaphylactic reactions occurred in IgG-negative patients (95% confidence interval, 0.0-3.1%); assay specificity was 98%. Preoperative IgE measurements were quantifiable In two of three reactive patients and in three nonreacting patients.Conclusions: Quantitative detection of antiaprotinin IgE and IgG lacks specificity for predictive purposes; however, quantitation of antiaprotinin Ige may identify patients at risk for developing an anaphylactic reaction to aprotinin reexposure.