Association of protamine IgE and IgG antibodies with life-threatening reactions to intravenous protamine.
Association of protamine IgE and IgG antibodies with life-threatening reactions to intravenous protamine.
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鱼精蛋白 IgE 和 IgG 抗体与静脉注射鱼精蛋白危及生命的反应之间的关系。
DOI：
10.1056/nejm198904063201402
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发表时间：
1989
期刊：
影响因子：
--
通讯作者：
AdkinsonJr,NF
中科院分区：
文献类型：
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作者：
Weiss,ME;Nyhan,D;Peng,ZK;Horrow,JC;Lowenstein,E;Hirshman,C;AdkinsonJr,NF
由于心导管和冠状动脉旁路手术的使用不断增加，静脉注射鱼精蛋白以逆转肝素抗凝的威胁生命的反应已被报道得越来越频繁。回顾研究表明，这种反应在每日皮下注射鱼精蛋白-胰岛素制剂的糖尿病患者中更为常见。为了确定抗鱼精蛋白IgE或IgG抗体是否可以解释鱼精蛋白-胰岛素依赖型糖尿病患者鱼精蛋白反应风险的增加，我们对27名患者(糖尿病患者和非糖尿病患者)进行了一项病例对照研究，这些患者对静脉注射鱼精蛋白有急性反应，而43名糖尿病患者在诊断或手术过程中对鱼精蛋白耐受无反应。在接受鱼精蛋白胰岛素注射的糖尿病患者中，血清抗鱼精蛋白IgE抗体的存在是急性鱼精蛋白反应的显著危险因素(相对风险，95；P=1.0x10-5)，抗鱼精蛋白免疫球蛋白抗体的存在(相对风险，38；P=1.2x10-5)也是显著的危险因素。没有接受过鱼精蛋白胰岛素注射的患者出现血清鱼精蛋白IgE抗体。在这组患者中，抗鱼精蛋白Ig G抗体是鱼精蛋白反应的危险因素(相对风险，25；P=0.0062)。我们得出结论，在鱼精蛋白-胰岛素依赖型糖尿病患者中，静脉注射鱼精蛋白时严重反应的风险增加似乎主要是由抗体介导的机制引起的。在非糖尿病受试者中，鱼精蛋白免疫球蛋白的存在显著增加了急性鱼精蛋白反应的风险，尽管许多有反应的非糖尿病受试者没有免疫球蛋白抗体。(英文)；320：886-92。
Life-threatening reactions to intravenous protamine, administered to reverse heparin anticoagulation, have been reported with increasing frequency as a consequence of the escalating use of cardiac catheterization and coronary bypass surgery. Retrospective studies have shown that such reactions are more common in diabetic patients receiving daily subcutaneous injections of protamine–insulin preparations. To determine whether antiprotamine IgE or IgG antibodies might explain the increased risk for protamine reactions among patients with protamine–insulin–dependent diabetes, we conducted a case-control study of 27 patients (diabetic and nondiabetic) who had acute reactions to intravenous protamine and 43 diabetic patients who tolerated protamine without a reaction during diagnostic or surgical procedures. Cases and controls were grouped according to previous exposure to protamine–insulin preparations.In diabetic patients who had received protamine–insulin injections, the presence of serum antiprotamine IgE antibody was a significant risk factor for acute protamine reactions (relative risk, 95; P = 1.0x10–5), as was antiprotamine IgG (relative risk, 38; P = 1.2x10–5). No patients without previous exposure to protamine–insulin injections had serum protamine IgE antibodies. In this group, antiprotamine IgG antibody was a risk factor for protamine reactions (relative risk, 25; P = 0.0062).We conclude that in protamine–insulin–dependent diabetics, the increased risk of serious reactions when intravenous protamine was given appeared to be caused largely by antibody-mediated mechanisms. In nondiabetic subjects, the presence of protamine IgG was significantly associated with an increased risk of acute protamine reactions, although many nondiabetic subjects who had reactions had no IgG antibodies. (N Engl J Med 1989; 320:886–92.)