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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 investigate the value of serum total IgE, tryptase and chymase in the identification of drug-induced atopic shock death. Methods The basic clinical data of non-allergic and lethal cases (235 cases) and drug-induced anaphylactic shock cases (32 cases) were analyzed in the cases of IgE levels and 10 cases of death caused by coronary heart disease and sudden death syndrome In the case of control group, the expression of tryptase and chymase in lung and myocardium of rats with allergic shock and control group were detected by immunohistochemistry, and the number of positive mast cells and integral optical density were calculated. Results The total IgE of 18 patients (56.25%) in the group of drug allergic shock was significantly higher than the upper limit of normal value 120 IU / mL, and 67 cases (28.51%) in non-atopic shock were higher than 120 IU / mL. The expression of tryptase and chymase in lung and myocardium were increased in the group of drug-induced atherosclerosis (P <0.05). Conclusion Immunohistochemical detection of tryptase and chymase in the identification of deaths caused by anaphylactic shock has more advantages than total serum IgE and is more suitable for the practical application.