葛根素引起急性溶血和肾功能衰竭的致病机制探讨

Exploration of pathogenic mechanism of acute hemolysis and renal failure induced by puerarin

目的 :探索葛根素引起急性溶血和肾功能衰竭 (肾衰 )的病理机制。方法 :作血液免疫学体外药物模拟抗球蛋白试验 (AGT)。以病人d 1,d 8及8mo的血样为标本 ,作直接抗球蛋白试验 (DAT)检测病人红细胞 (Pc)上的免疫复合物 ,行间接抗球蛋白试验 (IAT)检测O型供者红细胞 (Dc)与病人血清(Ps)、葛根素、补体孵育后在盐水介质及抗球蛋白血清 (AGS)中有否凝集或溶血。结果 :PcDAT阳性 ;IAT———孵育后的Dc在盐水介质中凝集 ,在IAT洗涤过程中部分溶血 ;在AGS中 ,Dc与抗 广谱AGS、抗 C3的凝集强于抗 IgG。单纯药物孵育的Dc不凝集 ,不加葛根素的Ps及加入葛根素的AB型供者体血清红细胞 (Ds)不凝集 ;8mo后重复Pc和Ps试验 ,凝集全部消失。结论 :Ps中含有可活化补体的IgM类抗葛根素抗体 ,此为急性血管内溶血。

AIM: To explore the pathogenic mechanism of acute hemolysis and renal failure induced by puerarin. METHODS: Antiglobulin test (AGT) of drug simulated in vitro were performed with hemo immunology. Blood samples were taken at d 1, d 8 and 8 mo of the onset. The immune complex on patient cell(Pc) was detected with direct antiglobulin test(DAT). Whether agglutination or hemolysis occurred was determined with indirect antiglebulin test (IAT) when the donor blood cell (Dc) incubated with patient serum (Ps), puerarin in normal saline (NS) media and antiglobulin serum(AGS). RESULTS: In DAT——Pc was positive. In IAT——Dc incubated Dc with Ps, would agglutinate strongly in NS media, but partly occur hemolysis in wash. Dc agglutinated with broad spectrum anti globulin serum and anti complement(C 3) stronger than with anti IgG serum. Dc didn't agglutinate when only incubated with pueranrin. Ps without pueranrin didn't aggluinate, nor did Dc with pueranrin. The agglutination didn't exist for Pc and Ps when repeated the above test after 8 mo. CONCLUSION: IgM, Anti puerarin antibody, which activating the complement exists in the patient's serum. It is the pathologic basis causing acute intravascular hemolysis and renal failure.