Protection Factors Of Immunology About The Anaphylactic Shock Induced By Cystic Echinococcosis In Patients

Objective: Disequilibrium among T regulating cell, cytokines and specific antibody was important turning point of anaphylactic shock caused by cystic echinococcosis besides classification and level variation of specific antibody.Therefore this shock had specificness.So begining from clinic and immunology according to earlier research foundation, this study analyzed retrospectively demographic characteristic and clinical characteristic of anaphylactic shock caused by cystic echinococcosis in patients, and proposed protection factors about demographic characteristic and clinical characteristic of anaphylactic shock caused by cystic echinococcosis in patients. We adopted prospective case-control study and discussed the changed feature of IgE、IgG、IgG1 in the happening and development of anaphylactic shock caused by cystic echinococcosis in patients so that we would find science clue to effective preventive measures and predicting prognosis for anaphylactic shock caused by cystic echinococcosis in patients. We analyzed the influence of cytokine immunological network regulation on specific antibody, and would illuminate the action mechanism of Th1/Th2 related cytokines in anaphylactic shock caused by cystic echinococcosis in patients, and proposed protective factors of cellular immunology of anaphylactic shock caused by cystic echinococcosis in patients. These would look for prevention and cure strategy of anaphylactic shock caused by cystic echinococcosis in patients.There was practical significance for raising safe and enlarging cure indication and improving prognosis and reducing mortality. Methods: The Internal Review Board of the First Affiliated Hospital of Xinjiang Medical University granted permission for this study. The research had undertaken retrospective analysis the records of 446 consecutive patients with cystic echinococcosis who were treated surgically at the first affiliated hospital of Xinjiang medical university between January 2008 and August 2009.The reviewer recorded the demographic and clinical features of the patients. A diagnosis of anaphylactic shock caused by cystic echinococcosis was confirmed in 10 of the patients (6 were female and 4 were male). We ruled out perioperative complications, such as infections and allergic shock caused by medication, other parasitic infections, or atopic diseases. To analyze the results, we designated the 10 patients with anaphylactic shock as GroupsⅠand the 436 patients without anaphylactic shock as GroupsⅡ.The patients’informations We collected included demographic charac- teristic, laboratory examination, imaging informations, clinical characteristic and cure and turnover informations. The other research had undertaken prospective case control study the records of 33 consecutive patients with cystic echinococcosis who were treated surgically at the first affiliated hospital of Xinjiang medical university between January 2008 and March 2010.we designated the 11 patients with anaphylactic shock as GroupsⅠand the 22 patients without anaphylactic shock as Group, and the two groups were matched according to 1∶2. We collected respectively venous blood at preoperation (T0), encyst ruptured instant time (T1), shock instant time (Tx), a hour after encyst ruptured time (T2), a day after encyst ruptured time (T3), a week after encyst ruptured time (T4).we adopted quantitative assay to IgE, IgG, IgG1, IgE, IL-4, IL-6, IL-12 and IFN-γby ELASA. Continuous variables are presented as median and inter-quartile range (IQR). The Mann-Whitney U test was used to compare continuous data between groups. Categorical variables are presented as counts and percentages, and Fisher’s exact test was used to assess associations between discrete and group variables. The quantitation data were presented by mean±standard deviation. We tested by variance analysis of repetitive measurement data for quantitation data and interclass variance analysis of the two groups. The rest data only analyzed data by descriptive statistics. Analyses required a P value of≤0.05 to be considered statistically significant and were performed using SPSS 15.0 statistics software. Results: We reviewed the records of 446 patients who were treated surgically for cystic echinococcosis to identify risk factors for anaphylactic shock. Of the 446 patients, 10 had final diagnoses of anaphylactic shock induced by cystic echinococcosis; none died. The 10 patients in groupsⅠwere significantly younger than those in groupsⅡ(P<0.001) There was no significant difference between groupsⅠandⅡin other variables of gender, ethnicity, whether they were from a livestock farming area or not, history of drug allergy, time for being in a farm area, or having had contact with dogs or cattle. There was no significant difference between the two groups for number of patients with a cyst or daughter cysts, cyst infect-ion, recurrence of echinococcosis, and results of DIGFA. Cysts that occurred in the lungs and cysts that ruptured were significantly associated with anaphylactic shock. Fifty perc-ent of the patients in groupsⅠ, but only 9.4% in groupsⅡhad cysts in the lung (P=0.002). Forty percent of patients in groupsⅠ, but only 11.2% in groupsⅡhad a ruptured cyst (P=0.022). Hepatic cysts were classified as shown in Table 3. Most hepatic cysts were CE2 (85.7% in groupsⅠand 66.6% in groupsⅡ), and there was no significant association bet-ween the classification and anaphylactic shock. Laboratory examination results for patients in groupsⅠbefore and within 24 hours after surgery are summarized. The neutrophil count increased significantly after the surgery, while the lymphocyte and eosinophil counts decreased significantly. One patient in groupsⅠhad a single hydatid cyst that ruptured and had an infection in the right lung; others had multiple cysts without rupture and infection, in stage CE2. Two cases had a cyst more than 10 cm in diameter.Uninfected cysts and cysts with high pressure were punctured before detachment to avoid rupture during detachment. Cysts ruptured with minimal leakage during cyst dissection in five cases in groupsⅠand with moderate leakage in the other five.Anaphylactic shock occurred five to 25 minutes after cyst puncture. Five cases had skin rashes, mostly with redness and scattered patches and macules. Within 5 to 25 minutes of cyst puncture or rupture, eight cases had increasingly coarse breath sounds with wheezing, airway resistance exceeding the baseline resistance of 10 cm H2O/L/S, hypoxemia, and hypotension at the same time or later with a drop of more than 30% from the baseline value. Six cases had sinus tachycardia with more than 120 beats per minute. All 446 cases received corticoid before surgery for preventing anaphylactic shock. Patients with anaphylactic shock were given pure oxygen and fluid therapy while under general anesthesia. The fluid therapy, which aimed to supplement the third-space fluid, included lower substituted hydroxyethyl starch (HES) solutions (Hydroxyethyl Starch 130/0.4 and Sodium Chloride Injection; Voluven ?; Fresenius Kabi, Bad Homburg, Germany), Ringer’s, Gelofusine, serum suspension, red cell suspension, and others, at an average rate of 14.6 to 60.5 mL/kg. Five cases received dopamine, with a total amount of 50μg to 1 mg, running at 5 to 25μg every five minutes. Four cases had persistent hypotension; a dopamine pump with 2 mg/kg/min continuous infusion for 35 to 125 minutes was used for them.For IgE, there were statistically significant between groupsⅠand groupsⅡexcept one hour after cysts ruptured. For IgG, there were statistically significant between groupsⅠand groupsⅡexcept preoperative. For IgG1, there were statistically significant between groupsⅠand groupsⅡexcept instant time that cysts ruptured and one week after cysts ruptured. For IgE/IgG1, there were not statistically significant between groupsⅠand groupsⅡ. In groupsⅠ, serum IFN-γwas nadir at the instant time hydatid fluid flew over, and raise up peak at the seventh day after hydatid fluid flew over, just as IL-4.IL-6 raise up at the instant time hydatid fluid flew over, and rised up peak at the seventh day after hydatid fluid flew over.IL-12 rised up at the instant time hydatid fluid flew over, and rised up peak at one hour after hydatid fluid flew over, and droped to basal level at the seventh day after hydatid fluid flew over. IgE began to drop at the instant time hydatid fluid flew over, and raise up to basal level at the seventh day after hydatid fluid flew over. IFN-γ, IL-4, IL-12, IL-6, IgE in groupsⅠwere positively correlated between all. Conclusions Younger, lung cystic echinococcosis, and excision of internal capsule were the risk factors of anaphylactic shock induced by cystic echinococcosis. The predicter fitting to present methods of diagnosis and treatment would depend on more study. It is the key point to avoid the serious complication of cystic echinococcosis that strengthening protection in operation, and actively preventing beforehand that hydatid fluid breaks in body cavity or blood flow to cause anaphylactic shock or even sudden death. Once discovering hydatid fluid outleakaging, airway resistance increasing and blood press descending, it is very important that we should immediately undertake operations research to clean up thoroughly the anaphylactogen that reside in daughter cyst, granddaughter and hydatid fluid meanwhile we undertook anti-shock and anti-hypersensitive. Immunological mechanism of anaphylactic shock induced by cystic echinococcosis was complex. High level of IgE, IgG and IgG1 predicted easy occurrence of anaphylactic shock after hydatid fluid flew over.IgG1 may be specific antibody of allergic reaction, the level of IgG1 had reference value for the prognosis of anaphylactic shock induced by cystic echinococcosis. IgE/IgG1 was not influence on the occurrence, development and prognosis of anaphylactic shock induced by cystic echinococcosis. Cytokines type not only effected the occurrence and development of anaphylactic shock induced by cystic echinococcosis and also effected disease outcomes. The patients of anaphylactic shock induced by cystic echinococcosis existed not only Th2 reaction str-engthens, also Th1 immune response gained advantage, confirmed cured patients immu-nological pathogenesis of anaphylactic shock induced by cystic echinococcosis was diff-erent from the otherⅠtype immediate anaphylactic shock. Th1 immune response gained advantage in cured patients of anaphylactic shock induced by cystic echinococcosis, IL-12 suppressed IgE synthesis, changed the anaphylactic shock levels of antibodies, made patients of anaphylactic shock induced by cystic echinococcosis, to good outcomes.