血清总IgE、类胰蛋白酶和类糜蛋白酶在药物过敏性休克死亡鉴定中的应用  

Application of Serum Total IgE,Tryptase and Chymase in the Identification of Death Caused by Drug Anaphylactic Shock

作　　者：王红杰[1] 宋纬平 阳宇[3] 黄京璐[4] 郝博[4] 高迪[4] 汤大为[4] 王小广[4] 刘水平[4] 权力[4] 罗斌[4] 

机构地区：[1]中山市公安局小榄分局,广东中山528415 [2]中山市公安局东升分局,广东中山528414 [3]广东省中医院病理科,广东广州510120 [4]中山大学中山医学院法医学系,广东广州510080

出　　处：《法医学杂志》2012年第3期167-171,共5页Journal of Forensic Medicine

基　　金：国家自然科学基金资助项目(39700167)

摘　　要：目的探讨血清总IgE、类胰蛋白酶和类糜蛋白酶表达在药物过敏性休克死亡鉴定中的应用价值。方法分析已检测IgE水平案例中非过敏致死案例(235例)和药物过敏性休克致死案例(32例)的基本临床资料,选取非药物过敏案例中冠心病致死和青壮年猝死综合征致死各10例为对照组,应用免疫组织化学法对药物过敏性休克组和对照组肺和心肌组织中的类胰蛋白酶与类糜蛋白酶表达进行检测,计算阳性肥大细胞数及积分光密度值。结果药物过敏性休克组中18例(56.25%)血清总IgE值明显高于正常值上限120 IU/mL,非过敏性休克案例中67例(28.51%)高于120 IU/mL。药物过敏性休克组肺与心肌组织中的类胰蛋白酶和类糜蛋白酶的表达均升高(P<0.05)。结论在药物过敏性休克死亡案件的鉴定中,类胰蛋白酶、类糜蛋白酶的免疫组织化学检测比血清总IgE有更大的优势,更适合在实际检案中应用。Objective To explore the application value of serum total IgE, tryptase and chymase in the iden- tification of death caused by drug anaphylactic shock. Methods The general information from 235 cases of non-drug anaphylactic shock and 32 cases of drug anaphylactic shock were analyzed. The serum IgE level had been detected in the cases. Ten cases caused by coronary disease and 10 cases caused by sudden manhood death syndrome were selected from non-drug anaphylactic shock cases for the control group. Expressions of tryptase and chymase in the lung and heart were detected using immunohistochemistry method. The num- ber and IOD of positive mast cells were counted. Results In the drug anaphylactic shock group, the IgE value of 18 samples（56.25%） was significantly higher than the norulal upper limit of 120IU/mL. In the non- drug anaphylactic shock group, the IgE value of 67 samples（28.51%） was higher than 120 IU/mL. The expres- sions of tryptase and chymase were significantly increased in lung and myocardial tissue in drug anaphy- lactic shock group（P〈0.05）. Conclusion Tryptase and chynmse are more superior than that of the serum to- tal IgE in the diagnosis of death caused by drug anaphylactic shock, and are more suitable in forensic practice.

关 键 词：法医病理学 过敏反应 免疫球蛋白E 类胰蛋白酶 类糜蛋白酶 

分 类 号：R593.1[医药卫生—内科学]