蜜蜂蜂毒致严重过敏反应临床特征  

Clinical Characteristics of Anaphylaxis Induced by Honeybee Venom

作　　者：关凯[1] 李丽莎[1] 王瑞琦[1] 尹佳[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院变态(过敏)反应科,北京100730

出　　处：《中华临床免疫和变态反应杂志》2016年第3期197-201,共5页Chinese Journal of Allergy & Clinical Immunology

基　　金：公益性行业科研专项类(201502012)

摘　　要：目的 探讨蜜蜂蜂毒致严重过敏反应的临床特点。方法 回顾性分析2010年至2016年在北京协和医院确诊为蜜蜂蜂毒致严重过敏反应的患者临床资料,根据蜇刺后各系统症状和体征分为Ⅰ-Ⅳ级严重过敏反应,分析患者生活地域、暴露类型等特点,初步探索变应原组分对鉴别蜜蜂蜂毒和胡蜂蜂毒交叉反应、双重过敏的临床意义。结果 30例蜜蜂蜂毒致严重过敏反应患者的男女之比为12∶18（2∶3）,平均年龄35（27,38）岁。70.0%（21/30）来自京津冀地区,23.3%（7/30）生活在市区,76.7%（23/30）生活在郊区。各级严重过敏反应构成：Ⅰ级20.0%（6/30）,Ⅱ级26.7%（8/30）,Ⅲ级40.0%（12/30）,Ⅳ级13.3%（4/30）。蜜蜂蜂毒暴露类型：自然性6.7%（2/30）,职业性86.7%（26/30）,医源性6.7%（2/30）,其中养蜂者高达86.7%。30例患者i1（蜜蜂蜂毒）sIgE检测结果为12.80（2.80,33.50）kUA/L,其中19例患者完成了蜜蜂蜂毒变应原组分i208（磷脂酶A2）sIgE检测;在8例i1和i3（胡蜂蜂毒）sIgE均为阳性的患者中,7例胡蜂蜂毒变应原组分i209（抗原V5）sIgE〈0.10 kUA/L,仅1例i209 sIgE为8.03 kUA/L,证实为双重过敏。33%（10/30）的患者在首次蜜蜂蜇刺后表现为大局部反应,3个月至1年后再次蜜蜂蜇刺后出现严重过敏反应。结论 职业性暴露是蜜蜂蜂毒致严重过敏反应最常见的暴露类型,使用变应原组分检测有助于确诊蜜蜂蜂毒和胡蜂蜂毒双重过敏。Objective To investigate the clinical characteristics of honeybee venom induced anaphylaxis. Methods Cases of anaphylaxis induced by honeybee sting were collected and analyzed retrospectively since 2011 to 2016 in Peking Union Medical College Hospital. The severity was classified into Grades I to IV based on the systemic manifestations after honeybee sting. Patients＇ residence and exposure types were also analyzed. The role of venom allergenic components sIgE tests was evaluated preliminarily in distinguishing dual allergic reactions from cross-reactivity. Results Gender ratio among 30 cases was： 12 （male） ：18 （female） and average age was 35 years-old （27, 38）. 70. 0% （21/30） of the patients lived in BTH （Beijing-Tianjin-Hebei） region; 23.3% （7/30） in urban areas whereas 76.7% （23/ 30） in rural areas. The distribution of severity of systemic reactions was Grade I （6/30）, Grade II （8/30）, Grade III （12/30） and Grade IV （4/30） respectively. There were three kinds of exposure types as following： natural （2/30）, occupational （26/30） and iatrogenic （2/30）. 86. 7% of the patients were beekeepers. The average od il （honeybee venom） slgE detection results was 12.80 （2. 80, 33.50） kUA/L among 30 patients. 19 of 30 patients finished i208 （ phospholipase A2 ）, i3 （ wasp venom） and i209 （antigen 5 ） detections. Only one patient whose i209 level was 8.03 kUA/L was confirmed as dual allergy to both honeybee and wasp venom among the 8 patients who had both positive results to both il and i3, the other 7 patients＇ i209 detection results were all less than 0. 10 kUA/L. 33% （10/30） of patients were attacked by large localized reactions after first sting, whereas anaphylaxis could be induced by second sting within 3 - 12 months. Conclusions Occupational exposure was the most common cause of honeybee venom anaphylaxis. Allergenic components slgE can be a useful diagnostic tool in the determination of dual venom allergic reactions.

关 键 词：蜂毒液类 过敏反应 变应原 

分 类 号：R593.1[医药卫生—内科学]