青霉素类药物的化学结构与其交叉过敏反应

目的 探讨青霉素类药物的化学结构与其交叉过敏反应的关系。方法 采用放射免疫吸附试验(radioallergosorbent test, RAST)方法检测133例青霉素过敏患者血清中针对4种青霉素类药物的8种特异性IgE抗体，采用RAST抑制实验和单个核细胞增殖实验研究青霉素类药物的化学结构与其交叉过敏反应的关系。结果 8种特异性IgE抗体的总阳性率为59.40%(79/133)，仅对一种药物抗体呈阳性的占26.36%(35/133)，不同药物间血清特异性IgE抗体存在交叉反应的占33.08%(44/133)。RAST抑制实验表明，有的病例侧链的抑制率与药物相近，母核抑制率最低；有的病例母核抑制率最高，药物及其各侧链结构的抑制率相近。细胞增殖实验显示，药物、侧链、母核均诱导外周血单个核细胞增殖。其中，药物诱导细胞增殖能力较强，而侧链诱导细胞增殖能力最弱。结论

Studies on the structural recognition of a cross-reacting determinant in patients with penicillins allergy

Objective To investigate the structural recognition of a cross-reacting determinant in patients with penicillins allergy.Methods Radioallergosorbent test(RAST)was used to detect eight kinds of specific IgE to penicillins in 133 sera of penicillin allergic patients.RAST inhibition tests were employed to identify the fine structure features recognized by IgE antibodies.PBMC obtained from subjects were stimulated with different chemical structure of penicillins,and identify the proliferative responses of peripheral blood lymphocyte(PBL).Results The rate of positive reactions for the specific IgE antibodies was 59.40%(79/133).The positive cases only to one drug were 35(26.36%),the cross-reactivity cases among different drugs were 44(33.08%).RAST inhibition studies showed that penicillins and side-chain structure of penicillins showed good inhibitory activity.6-Aminopenicillanic acid(6-APA)was the weakest inhibitor.Results of another serum indicated that 6-APA was the strongest inhibitors,while molecules representing their side-chains and drugs were proved to be the next best inhibitors.The results of the proliferative responses of peripheral blood lymphocyte showed that 6-APA,molecules representing their side-chains and drugs all can stimulate the proliferations of lymphocytes,and the proliferations of lymphocytes stimulated by the molecule representing their side-chains were lower than that stimulated by penicillins-treated groups.Conclusion Partial cross-reactivity existed among different kinds of penicillins.6-APA and the groups,making up part of the different side-chains on penicillins,are all accounted for the cross-reactivity.