类胰蛋白酶与过敏性休克死亡的法医学鉴定.pdfVIP

· 132 · Journal of Forensic Medicine，August 2002，Vo1．1 8．No．3 类胰蛋白酶与过敏性休克死亡的法医学鉴定 沈忆文 ，陆超2赵子琴 ，薛爱民 ，殷莲华 (复旦大学上海医学院：1．法医学系，2．生理与病理生理学系， 上海 200032) [摘 要】目的 探讨类胰蛋白酶与过敏性休克的关系。方法 从类胰蛋白酶的生物学特性、正常人分布、检 测方法及其与过敏性休克的关系，并应用ELISA方法检测三例尸体血清类胰蛋白酶的浓度，对三例过敏性 休克死亡的案例作回顾性分析。结果 两例血清中类胰蛋白酶的含量分别为52ng／ml和 121ng／ml(高于正常 值 l0倍以上)，另一例浓度为0．73ng／ml。结论 诊断过敏性休克，类胰蛋白酶含量的检测是很有意义的，但 不能单凭检测结果下结论。 [关键词】类胰蛋白酶；过敏性休克；ELISA [中图分类号】DF795．4 [文献标识码】A [文章编号】1004—5619(2002)03—0132—03 Tryptase and fatal anaphy laxic reaction SHEN Yi—wen，LU Chao，ZHA 0 Zi-qin，et a1． (Department of Forensic Medicine，Shanghai Medical School,Fudan Universio；Shanghai 200032) [Abstract]0bjecfive Toinvestigate the relationship between tryptase in serum and anaphylaxis．Methods 11he concentrations of tryptase in the sera of heart blood in three persons died from anaphylaxis shock were detected by ELISA．The first sample was obtained from a man，aged 38，died of injecting Amikacin． The second sample was obtained from a man，aged 42，died of injecting Cephradine．The third sample was from a woman，aged 39，died of injecting Lincomycin．All samples were stored in-20~C．Results The concentrations of tryptase in sera were 52ng／m1．1 2 I ng／ml and 0．73ng／m1．It was unknown why the concentration of tryptase in the third sample was norma1．Conclution In fetal anaphylaxia reaction tryptase measurement is a useful indicator，but the diagnosis is not to be based on the test alone． [Key words】tryptase；anaphylaxis shock；ELISA 过敏性休克死亡尸体常无特异性病理学改变，诊 绀而死亡。死后24h进行尸体剖验，发现：死者生前患 断往往依据临床表现、非特异性形态学改变 (如肺水 有急性支气管炎，心、肺、肝、脾、肾等全身器官高度淤 肿、多器官淤血、无致死性病理学改变等)，且排除损 血、水肿，未发现致死性疾病改变，也未发现致死性机 伤、窒息和中毒而得出。尽管有一些灵敏的方法(放射 械性损伤、机械性窒息改变；心血未检出常见毒物。 酶、免疫学技术)可以检测血浆中组胺含量的变化，帮 案例2：某男，42岁，某日因“喉痛”，前往某个体行 助诊断过敏反应，但由于组胺很快释放、迅速降解，实