血小板活化因子、血小板活化因子乙酰水解酶和严重过敏反应
2008/06/06
血小板活化因子参与动物过敏反应，其抑制剂可预防动物过敏反应的发生。有关血小板活化因子及其乙酰水解酶在人类过敏反应的作用尚不明确。
作者检测了41例过敏反应患者血清血小板活化因子水平，与23例患者进行了对照。比较了其中9例致死花生过敏患者血小板活化因子乙酰水解酶活性和26例非过敏患儿、49例非过敏成人、63例总督花生过敏患儿、24例非致死过敏反应患者、10例非过敏反应儿童、15例致命哮喘患儿和19例非致命哮喘患儿的不同。
结果显示：血清血小板活化因子水平在过敏反应患者中明显增高，且与过敏反应严重程度相关。血清血小板活化因子水平增高比例在对照组为4%，1级过敏反应为20%，2级过敏反应为71%，3级过敏反应为100%。血清血小板活化因子水平与血小板活化因子乙酰水解酶活性负相关。低活性血小板活化因子乙酰水解酶患者过敏反应严重。致死花生过敏患者血小板活化因子乙酰水解酶活性明显降低。
血清血小板活化因子水平和血小板活化因子乙酰水解酶活性直接相关。致死花生过敏患者血小板活化因子乙酰水解酶活性明显降低。血小板活化因子乙酰水解酶灭活血小板活化因子失败导致严重过敏反应。
（刘颖格 第四军医大学西京医院呼吸内科 710032 摘译）
(n engl j med 358;1 www.nejm.28 org january 3, 2008)
Platelet-Activating Factor,
PAF Acetylhydrolase, and Severe Anaphylaxis
Peter Vadas, M.D.,Ph.D.,Milton Gold, M.D.,Boris Perelman,Ph.D.,
Gary M. Liss, M.D., Gideon Lack, M.D., Thomas Blyth, M.D.,
F.Estelle R.Simons, M.D., Keith J.Simons, Ph.D.,Dan Cass, M.D.,
and Jupiter Yeung, Ph.D.
Background
Platelet-activating factor (PAF) is an important mediator of anaphylaxis in animals,and interventions that block PAF prevent fatal anaphylaxis. The roles of PAF and PAF acetylhydrolase, the enzyme that inactivates PAF, in anaphylaxis in humans have not been reported.
Methods
We measured serum PAF levels and PAF acetylhydrolase activity in 41 patients with anaphylaxis and in 23 control patients. Serum PAF acetylhydrolase activity was also measured in 9 patients with peanut allergy who had fatal anaphylaxis and compared with that in 26 nonallergic pediatric control patients, 49 nonallergic adult control patients, 63 children with mild peanut allergy, 24 patients with nonfatal anaphylaxis, 10 children who died of nonanaphylactic causes, 15 children with life-threatening asthma, and 19 children with non–life-threatening asthma.
Results
Mean (±SD) serum PAF levels were significantly higher in patients with anaphylaxis (805±595 pg per milliliter) than in patients in the control groups (127±104 pg per milliliter, P<0.001 after log transformation) and were correlated with the severity of anaphylaxis. The proportion of subjects with elevated PAF levels increased from 4% in the control groups to 20% in the group with grade 1 anaphylaxis, 71% in the group with grade 2 anaphylaxis, and 100% in the group with grade 3 anaphylaxis (P<0.001). There was an inverse correlation between PAF levels and PAF acetylhydrolase activity (P<0.001). The proportion of patients with low PAF acetylhydrolase values increased with the severity of anaphylaxis (P<0.001 for all comparisons). Serum PAF acetylhydrolase activity was significantly lower in patients with fatal peanut anaphylaxis than in control patients (P values <0.001 for all comparisons).
Conclusions
Serum PAF levels were directly correlated and serum PAF acetylhydrolase activity was inversely correlated with the severity of anaphylaxis. PAF acetylhydrolase activity was significantly lower in patients with fatal anaphylactic reactions to peanuts than in patients in any of the control groups. Failure of PAF acetylhydrolase to inactivate PAF may contribute to the severity of anaphylaxis.n engl j med 358;1 www.nejm.28 org january 3,2008
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