痛风及高尿酸血症患者HLA-B^*5801基因携带情况及其与别嘌醇过敏反应间的相关性研究

HLA-B*5801 allele gene carrying status and its association with allergic reaction of allopurinol in patients with gout and hyperuricemia

目的调查南昌地区痛风及高尿酸血症患者HLA-B^*5801等位基因的携带情况,探讨其与别嘌醇过敏反应的相关性。方法对2018年6月至2019年1月在江西省人民医院就诊并服用别嘌醇的痛风及高尿酸血症患者进行分组,其中服用别嘌醇后发生过敏反应者(别嘌醇过敏组,11例)、服用别嘌醇6个月后未发生任何不良反应者(别嘌醇耐受组,21例)和未服用别嘌醇的痛风及高尿酸血症患者(对照组,80例)。取受试者外周静脉血,采用荧光定量PCR法检测其HLA-B^*5801等位基因,分析别嘌醇过敏与HLA-B^*5801等位基因之间的关联性。结果过敏组HLA-B^*5801等位基因阳性率为90.9%(10/11),耐受组为9.5%(2/21),对照组为13.8%(11/80),HLA-B^*5801等位基因阳性者发生过敏的风险显著高于阴性者(OR=95,95%CI:7.6~1180.3,P=0.000)。HLA-B^*5801等位基因检测预测别嘌醇致敏的敏感度及特异度分别为90.9%和90.5%。结论HLA-B^*5801等位基因与别嘌醇过敏具有相关性,患者服用别嘌醇前应检测HLA-B^*5801等位基因,可指导患者安全合理用药。

Objective To investigate the HLA-B^*5801 allele carrying station and it’s correlation of allergic reaction caused by allopurinol in the Patients with gout and hyperuricemia of Nanchang City.Methods All the patients with gout and hyperuricemia received treetment in Jiangxi Provincial People's Hospital from Jun.2018-Jan.2019.The patients with allergic reaction after receiving allopurinol were enrolled in allopurinol allergy group(11 cases),the patients without any adverse reaction taking allopurinol over 6 months were enrolled in allopurinol tolerance group(21 cases)and 80 patients not taking allopurinol were enrolled in control group.The subjects peripheral blood samples were taken to detect HLA-B^*5801 allele by fluorescence quantitative PCR,in order to analyze the association between allopurinol allergy and HLA-B^*5801 allele.Results The positive rate of HLA-B^*5801 allele was 90.9%(10/11)in allopurinol allergy group,9.5%(2/21)in allopurinol tolerance group,and 13.8%(11/80)in control group.The risk of allergic reaction was significantly higher in subjects with positive HLA-B^*5801 allele than those with negative HLA-B^*5801 allele(OR=95,95%CI:7.6~1180.3,P=0.000).The sensitivity and specificity of the HLA-B^*5801 allele for prediction of allopurinol allergy were 90.9%and 90.5%.%,respectively.Conclusion HLA-B^*5801 allele is correlated with allergy to allopurinol.Patients should detect HLA-B^*5801 allele before taking allopurinol,so that patients can use drugs safely and rationally.