接受血液透析患者的超敏反应
2018/01/05
摘要
目的：描述接受持续性血液透析患者的超敏反应数据来源：PubMed搜索过去30年相关文献，特别是近10年的文献
研究筛选：所有描述血液透析患者发生超敏反应的病例报道和综述性文章
结果：药物相关超敏反应是血液透析患者最常见的病因，包括铁剂，促红素以及肝素，这些可以引发过敏性或假过敏性反应，还有抗生素和麻醉药物科导致迟发型超敏反应。许多超敏反应经补体激活和缓激肽增加触发，尤其是在ACEI类药物应用的情况下。部分可替代药物的制备和透析膜也会造成超敏反应，一旦应用过程中出现即可明确，在今日后的工作中血透相关医务人员应予以重视避免再次发生。
结论：尽管超敏反应在血透患者中并不常见，但仍可能有生命危险。此外，考虑到终末期肾病人群广大，出现此类反应的情况也不在少数。大多数为假过敏性反应，并非经IgE介导。血透患者潜在暴露的多样性和环境的复杂性都会使明确过敏反应的病因极具挑战。需要大量的努力研究超敏反应以避免在这一高风险人群中反复发生。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Ann Allergy Asthma Immunol. 2017 Jun;118(6):680-684. doi: 10.1016/j.anai.2017.04.006.）
（Ann Allergy Asthma Immunol. 2017 Jun;118(6):680-684. doi: 10.1016/j.anai.2017.04.006.）
Hypersensitivity reactions in patients receiving hemodialysis.
Ann Allergy Asthma Immunol. 2017 Jun;118(6):680-684. doi: 10.1016/j.anai.2017.04.006.
Butani L, Calogiuri G.
AbstractOBJECTIVE: To describe hypersensitivity reactions in patients receiving maintenance hemodialysis.
DATA SOURCES:PubMed search of articles published during the past 30 years with an emphasis on publications in the past decade.
STUDY SELECTIONS:Case reports and review articles describing hypersensitivity reactions in the context of hemodialysis.
RESULTS:Pharmacologic agents are the most common identifiable cause of hypersensitivity reactions in patients receiving hemodialysis. These include iron, erythropoietin, and heparin, which can cause anaphylactic or pseudoallergic reactions, and topical antibiotics and anesthetics, which lead to delayed-type hypersensitivity reactions. Many hypersensitivity reactions are triggered by complement activation and increased bradykinin resulting from contact system activation, especially in the context of angiotensin-converting enzyme inhibitor use. Several alternative pharmacologic preparations and dialyzer membranes are available, such that once an etiology for the reaction is established, recurrences can be prevented without affecting the quality of care provided to patients.
CONCLUSION:Although hypersensitivity reactions are uncommon in patients receiving hemodialysis, they can be life-threatening. Moreover, considering the large prevalence of the end-stage renal disease population, the implications of such reactions are enormous. Most reactions are pseudoallergic and not mediated by immunoglobulin E. The multiplicity of potential exposures and the complexity of the environment to which patients on dialysis are exposed make it challenging to identify the precise cause of these reactions. Great diligence is needed to investigate hypersensitivity reactions to avoid recurrence in this high-risk population.
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