Amniotic Fluid Embolism: Anaphylactic Reactions With Idiosyncratic Adverse Response
Amniotic Fluid Embolism: Anaphylactic Reactions With Idiosyncratic Adverse Response
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DOI：
10.1097/ogx.0000000000000197
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发表时间：
2015-08-01
影响因子：
6.2
通讯作者：
Kobayashi, Hiroshi
中科院分区：
文献类型：
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作者：
Kobayashi, Hiroshi
羊水栓塞（AFE）是一种罕见但严重的产科急症。本研究的目的是调查AFE的病理生理学。方法通过1966年至2014年的英语文献进行检索（在线MEDLINE PubMed数据库）使用关键词羊水栓塞与过敏反应、类过敏反应、补体激活、肥大细胞、胎儿抗原，结果羊水栓塞是一种罕见的临床实体，但严重的产科急诊，可以是致命的，即使在以前健康的妇女在劳动力或在产后早期。至少有两种机制。首先，AFE中的不良反应通常是意外的，并且具有胎儿抗原剂量依赖性。由于羊水灾难性地进入母体循环，他们会经历突然的心肺衰竭（机械性阻塞亚型）。其次，剩余AFE的速发过敏反应和类速发过敏反应也是相对非预期的，与胎儿抗原剂量无关，可在首次暴露于羊水成分时发生。它们与补体激活和随后的产后出血有关。心脏肥大细胞是过敏性心脏病的中心发病机制（免疫球蛋白E依赖性）和类过敏性结论最近的免疫学研究为AFE的病理生理学研究提供了一种新的方法。目标受众妇产科医生，家庭医生。学习目标在阅读本文后，学习者应该能够更好地诊断患有AFE的妇女，并根据需要为患者提供信息;描述了与AFE相关的不良反应，表明一些AFE患者会发生突发心肺衰竭（机械性梗阻亚型）通过大量羊水进入母体循环;确定剩余AFE的过敏性和类过敏反应，证明它们与补体激活和随后的产后出血相关;分析和讨论了近年来免疫学研究为AFE病理生理学研究提供的新途径。
ProblemAmniotic fluid embolism (AFE) is a rare but severe emergency in obstetrics. The aim of the present study was to investigate the pathophysiology of AFE.MethodsA search was conducted between 1966 and 2014 through the English-language literature (online MEDLINE PubMed database) using the keyword amniotic fluid embolism combined with anaphylaxis, anaphylactoid, complement activation, mast cells, fetal antigens, and idiosyncratic.ResultsAmniotic fluid embolism is a rare clinical entity but a severe obstetric emergency that can be lethal even in previously healthy women in labor or in the early postpartum period. There appears to be at least 2 mechanisms. First, adverse reactions in AFE are usually unexpected and fetal antigen dose dependent. Given the disastrous entry of amniotic fluid into the maternal circulation, they experience a sudden cardiopulmonary collapse (mechanical obstruction subtype). Second, anaphylactic and anaphylactoid reactions of the remaining AFE are also relatively unexpected and fetal antigen dose independent and can occur at the first exposure to amniotic fluid components. They are associated with complement activation and subsequent postpartum hemorrhage. Cardiac mast cells constitute a central pathogenesis of anaphylactic (immunoglobulin E-dependent) and anaphylactoid (immunoglobulin E-independent) reactions.ConclusionsRecent immunologic studies provide a new approach to the study of the pathophysiology of AFE.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter reading the article, the learner should be better able to diagnose women with AFE and provide information to patients as needed; describe adverse reactions associated with AFE, demonstrating that some AFE patients experience a sudden cardiopulmonary collapse (mechanical obstruction subtype) through the entry of a large amount of amniotic fluid into the maternal circulation; identify anaphylactic and anaphylactoid reactions of the remaining AFE, demonstrating that they are associated with complement activation and subsequent postpartum hemorrhage; and analyze and discuss the recent immunologic studies that provide a new approach to the study of the pathophysiology of AFE.