流式细胞术辅助嗜碱性粒细胞激活试验对罗库溴铵致围术期过敏性休克的诊断价值  

Value of flow cytometry assisted basophil activation test to the diagnosis of perioperative anaphylactic shock induced by rocuronium

作　　者：刘坤[1] 曹彬 齐正[1] LIU Kun;CAO Bin;QI Zheng(Department of Anesthesiology,Perioperative and Pain Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院麻醉与围手术期及疼痛医学部,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2025年第1期72-77,共6页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金青年基金项目(82201331)。

摘　　要：目的 分析罗库溴铵致围术期过敏性休克(PAS)的影响因素,探讨流式细胞术辅助嗜碱性粒细胞活化试验诊断罗库溴铵致PAS的价值。方法 2021年1月—2023年12月郑州大学第一附属医院发生PAS患者36例为观察组,均于术后4~6周行皮内试验证实过敏原为罗库溴铵。同期麻醉方案与观察组相同但未发生PAS者36例为对照组。于观察组过敏症状消退后4~6周,采集2组外周血行罗库溴铵刺激嗜碱性粒细胞活化试验,应用流式细胞术检测2组嗜碱性粒细胞表面活化标志物CD63、CD203c阳性表达情况,计算阳性对照管CD63刺激指数(SI)(SI_CD63)、阳性对照管SI_CD203c、刺激管SI_CD63、刺激管SI_CD203c。比较2组女性、食物过敏史、药物过敏史、既往手术史、术前口服降压药比率以及阳性对照管SI_CD63、阳性对照管SI_CD203c、刺激管SI_CD63、刺激管SI_CD203c;采用多因素logistic回归分析罗库溴铵致PAS的危险因素;绘制ROC曲线,评估全血样本采用罗库溴铵刺激后SI_CD63和SI_CD203c诊断罗库溴铵致PAS的效能。结果 (1)观察组女性(58.3%)及有食物过敏史(44.4%)、既往手术史(44.4%)比率均高于对照组(25.0%、19.4%、13.9%)(χ^(2)=6.250~9.425,P均<0.05),有药物过敏史、术前口服降压药比率与对照组比较差异均无统计学意义(P>0.05)。(2)观察组刺激管SI_CD63(3.74±1.61)、刺激管SI_CD203c(4.33±3.09)均高于对照组(0.99±0.18、1.33±1.02)(t=6.281、8.162,P均<0.05),阳性对照管SI_CD63、阳性对照管SI_CD203c与对照组比较差异均无统计学意义(P>0.05)。(3)女性(OR=4.085,95%CI:1.309~12.710,P=0.015)、有食物过敏史(OR=5.064,95%CI:1.497~17.208,P=0.009)、有既往手术史(OR=6.404,95%CI:1.770~23.085,P=0.005)是罗库溴铵致PAS的危险因素。(4)罗库溴铵刺激后SI_CD63、SI_CD203c分别以2.38、2.27为最佳截断值,诊断罗库溴铵致PAS的AUC分别为0.896(95%CI:0.81~0.97,P=0.002)、0.939(95%CI:0.88~0.99,P=0.003),灵敏度分别为77.8%、83.3Objective To analyze the influencing factors of rocuronium-induced perioperative anaphylactic shock(PAS),and to investigate the value of flow cytometry assisted basophil activation test(BAT)to the diagnosis of PAS induced by rocuronium.Methods Thirty-six patients with PAS were confirmed rocuronium as allergen by intradermal test 4-6weeks after surgery in the First Affiliated Hospital of Zhengzhou University from January 2021 to December 2023 (the observation group),and another 36 patients receiving the same anesthesia regimen in the same period but with no PAS were included as the control group.Peripheral blood samples were collected from two groups to conduct rocuronium-stimulated BAT 4-6 weeks after the allergic symptoms subsided in the observation group,and the flow cytometry was used to detect the positive expressions of basophil surface activation markers CD63 and CD203c.The CD63 stimulation index(SI)(SI_CD63)and SI_CD203 cof positive control tube,and SI_CD63 and SI_CD203 cof stimulation tube were calculated.The proportions of females,food allergy history,drug allergy history,previous surgery history and preoperative oral antihypertensive use,and SI_CD63 and SI_CD203 cof positive control tube and SI_CD63 and SI_CD203c of stimulation tube were compared between two groups.Multivariate logistic regression was used to analyze the risk factors of rocuronium-induced PAS.ROC curves were plotted to assess the efficiencies of rocuronium-stimulated SI_CD63 and SI_CD203 cof whole blood samples on diagnosing PAS induced by rocuronium.Results (1)The proportions of females,food allergy history and previous surgery history were higher in the observation group (58.3%,44.4%,44.4%)than those in the control group (25.0%,19.4%,13.9%)(χ^(2)=6.250-9.425,all Pvalues<0.05).There were no significant differences in the proportions of drug allergy history and preoperative oral antihypertensive use between two groups(P>0.05).(2)The SI_CD63 and SI_CD203 cof stimulation tube were higher in the observation group(3.74±1.61,4.33±3.09)tha

关 键 词：围术期过敏性休克 罗库溴铵 流式细胞术 嗜碱性粒细胞激活试验 

分 类 号：R73[医药卫生—肿瘤]