药物抗体致病危害临床病例分析

Clinical Case Analysis for Drug Antibody’s Pathogenic Danger

目的通过血液免疫学药物抗体检测寻找药物中毒病因,结合临床表现进行病理分析,为病人提供可靠的实验诊断依据,指导临床治疗。方法:免疫血液学体外药物模拟,经典的抗球蛋白试验法。标本取自疑为利福平(RFP)、葛根素(PRR)及四环素(Tetracycline)所致急性溶血、急性肾衰和脏器功能损伤病人,共计57份(其中RBC标本32份);对照标本10例。直接抗球蛋白试验(DAT)检测病人红细胞(Pc)上的免疫复合物;间接抗球蛋白药物模拟试验(IAT)检测病人血清(Ps)、药物、补体(或灭活补体)孵育过的试剂红细胞(Dc)在抗人球蛋白试剂(AGS)中的反应。同时设单纯药物损伤细胞试验及正常血清、细胞模拟对照。结果:被检病人红细胞DAT阳性率75％(24/32),血清抗体阳性率68％(39/57例)通过补体对比试验观察,灭活补体的RFP组与3种特异性AGS凝集全部消失;PRR组仅与抗-C_3凝集消失。终浓度1g/L利福平孵育的Dc在IAT中与广谱AGS出现极轻微凝集;葛根素组无变化。10例对照均为阴性。结论:药物免疫性抗体是造成急性溶血、肾功能衰竭以及组织器官损伤的真正病因,及时停药是治疗的关键步骤。

Purpose: Through hematoimmunological drug antibody detection to find out the cause of drug toxication, combi- ning the clinical manifestations to make pathological analysis, to provide reliable experimental diagnostic gist and to instruct clinical therapy. Method: Hematoimmunological drug imitation in vitro, a classical antiglobulin test took 57 samples (32 RBC samples) from the patients with chinical suspected drug-induced acute hemolysis, acute renal failure and organic damage. The drug included rifampicin, puerarin and tetracychine. at the same time, 10 contrast samples were taken. Direct anti-globulin test (DAT) was used todetect the immunocomplex on RBC (Pc), and indirect anti-globubin test (IAT) was used to detect the reaction of antiglobulin reagent to the RBC reagent (Dc) incubated in the patients'serum, drug and complement (or inactivate complement). At the same time, set simple drug-induced cellular injury test and imitation contrast test of normal serum and cells. Result: The positive rate RBC of patients in DAT was 75 percent (24/32), and that of serum antibody is 68 percent (39/ 57). However, for serum incubated with ritampicin in IAT with three specific AGS, the aggtutinatins of all were di- minisled when addifion inactivated complement, while in puerarin group in IAT, the results were unchanged, ex- cept the agglutinations disappears with anti-c_3 reagent. Dc which was incubated in RFP at a final ancentration of 1g/L could induced a weak agglutinates with anti-broad AGS in IAT, but there was no change in PRR. All the 10 contrast samples were negative. Conclusion: Drug immunological antibody is the genuine cause of acute he- molysis, renal failure and tissues organs injury, and drug withdrawl in time was the key process.