类胰蛋白酶和IgE测定在过敏性猝死诊断中的应用研究

Evaluation on the applicability of tryptase and IgE assay to postmortem diagnosis of the sudden death from hypersensitivity

目的探讨过敏性猝死法医学鉴定的诊断方法和指标。方法采取10例正常人、9例过敏性猝死和19例其他死因(排除过敏反应、冠心病)尸体的静脉血,采用荧光酶联免疫法(Pharmacia UniCAP100过敏原定量分析仪)和酶联免疫吸附试验ELISA法分别测定血清肥大细胞类胰蛋白酶和IgE含量,采用免疫组化方法观察过敏性猝死和其他死因的肺组织中的肥大细胞类胰蛋白酶免疫组化染色。结果过敏性猝死者的血清类胰蛋白酶和IgE含量升高,与其他死因之间的差异具有显著性意义(P<0.01),其他死因和正常人之间的差异无统计学意义(P(0.05);与其它死因相比,过敏性猝死肺组织中的肥大细胞类胰蛋白酶免疫组化阳性染色增强(P<0.01)。结论过敏性猝死者血清IgE和肥大细胞类胰蛋白酶含量显著升高;过敏性猝死者肺组织中肥大细胞类胰蛋白酶染色增强。

Objective To investigate a method for postmortem diagnosis of the sudden death from hypersensitivity by detection of serum tryptase and IgE. Methods Venous blood samples were collected from 9 cases of sudden death from hypersensitivity, 19 cases of death from other causes and 10 health living adult individuals. The serum levels of the mast cell tryptase （MCT） and IgE were detected with immunofluo- rescent enzyme assay and enzyme linked immunosorbent assay（ELISA） respectively. MCT in the lungs was detected by immunohistochemistical method. Results The serum level of both MCT and IgE in cases of sudden death from hypersensitivity were higher than those in health living adults and cases of death from other causes（P 〈 0.01 ）. However, there was significant difference （P 〉 0.05）in the serum level of IgE and MCT between the health living individuals and cases of death from other cause. More cells containing MCT-positive granules were detected in the lung in cases of sudden death from hypersensitivity than in cases of death from other causes（P 〈 0.01 ）. Conclusion The serum level of MCT and IgE in individuals with sudden death from hypersensitivity are higher than that in deaths from other causes, which may be used as objective diagnostic indications for medico-legal certification of death from anaphylactic shock.