蜂蜇伤发病机制和临床治疗的研究现状
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摘要
蜂蜇伤是急诊科医生经常遇到的疾病,大量蜂蜇伤会引起严重的临床反应,如果处理不当,会出现过敏性休克、急性喉头水肿、急性肾损伤、MODS等严重威胁生命的临床症状。过敏反应和直接毒性是其主要损伤机制。毒液免疫治疗是一种有效的治疗蜂蜇伤的方法,其安全性高,疗效好,可以明显减轻蜂蜇伤的毒性反应,降低蜂蜇伤的住院率、病死率,但我国尚未开展、普及。血液灌流和血液透析是目前公认的治疗急性肾损伤和MODS的最有效疗法,其可以滤过血液中的各种毒性分子,对保护肾脏和其他各重要脏器功能,降低病死率和住院天数等有重要意义。本文主要就蜂蜇伤的发病机制和临床治疗中的血液净化技术以及毒液免疫治疗研究现状综述如下,以期提高急诊科医生对蜂蜇伤的诊治水平。
Multipled wasp stings can cause serious toxic reactions. If handled improperly,there will be anaphylactic shock,acute laryngeal edema,acute kidney injury,MODS and other serious life-threatening clinical symptoms. Anaphylaxis and direct toxicity are the main mechanisms of injury. VIT( venom immunotherapy) is an effective method to treat wasp sting injury with high safety and good effect,which can significantly reduce the toxic reaction of sting injury and reduce the hospitalization rate and mortality. However,it has not been carried out and popularized in our country. Hemoperfusion and hemodialysis are currently recognized as the most effective therapies for acute kidney injury and MODS. They can filter various toxic molecules in the blood and have important significance in protecting kidney and other important organ functions,reducing mortality and hospitalization days. This paper mainly reviews the pathogenesis of wasp stings,blood purification technology in clinical treatment and the status quo of VIT in order to improve the level of diagnosis and treatment of wasp stings by emergency doctors.
Multipled wasp stings can cause serious toxic reactions. If handled improperly,there will be anaphylactic shock,acute laryngeal edema,acute kidney injury,MODS and other serious life-threatening clinical symptoms. Anaphylaxis and direct toxicity are the main mechanisms of injury. VIT( venom immunotherapy) is an effective method to treat wasp sting injury with high safety and good effect,which can significantly reduce the toxic reaction of sting injury and reduce the hospitalization rate and mortality. However,it has not been carried out and popularized in our country. Hemoperfusion and hemodialysis are currently recognized as the most effective therapies for acute kidney injury and MODS. They can filter various toxic molecules in the blood and have important significance in protecting kidney and other important organ functions,reducing mortality and hospitalization days. This paper mainly reviews the pathogenesis of wasp stings,blood purification technology in clinical treatment and the status quo of VIT in order to improve the level of diagnosis and treatment of wasp stings by emergency doctors.
引文
[1] Kulhari A,Rogers A,Wang H,et al. Ischemic Stroke After Wasp Sting[J]. J Emerg Med,2016,51(4):405-410.
[2] Akyildiz B,Ozsoylu S,Ozturk MA,et al. A fatal case caused by massive honey bee stings[J]. Turk J Pediatr,2015,57(6):611-614.
[3] Chen L,Huang G Z. Poisoning by toxic animals in China--18autopsy case studies and a comprehensive literature review[J].Forensic Sci Int,2013,232(1-3):e12-e23.
[4] Montagni M,Peveri S,Incorvaia C,et al. Scoliid Wasp Sting:A New Cause of Anaphylaxis[J]. J Investig Allergol Clin Immunol,2017,27(5):331-333.
[5] Galvez-Olortegui J,Alvarez-Vargas M,Durand-Vergara J,et al. Henoch Schonlein purpura associated with bee sting:case report[J]. Medwave,2015,15(9):e6297.
[6] Hon KL,Leung A. Bee or Wasp Sting[J]. Wounds,2017,29(9):E70-E72.
[7] Lai P,Yang J,Cui H,et al. Prognosis of corneal wasp sting:case report and review of the literature[J]. Cutan Ocul Toxicol,2011,30(4):325-327.
[8] Im JC,Kang YK,Park TI,et al. Sympathetic Ophthalmia after Ocular Wasp Sting[J]. Korean J Ophthalmol, 2015, 29(6):435-436.
[9] Gortzak K,Gortzak RA. Wasp and bee stings[J]. Ned Tijdschr Tandheelkd,2013,120(7-8):373-376.
[10] Nag SS,Ghosh N,Singh AK,et al. Nephritic syndrome following multiple bee stings:a late hypersensitivity reaction[J]. Paediatr Int Child Health,2015,35(2):157-159.
[11] Korosec P,Gibbs BF,Rijavec M,et al. Important and specific role for basophils in acute allergic reactions[J]. Clin Exp Allergy,2018,48(5):502-512.
[12] Casale TB,Burks AW. Clinical practice. Hymenoptera-sting hypersensitivity[J]. N Engl J Med,2014,370(15):1432-1439.
[13] Arslan M,Gungor A,Akin O,et al. A rare complication of wasp sting:acute cervical dystonia[J]. Childs Nerv Syst,2015,31(12):2213-2214.
[14] Volders J,Smits M,Folkersma G,et al. An unusual neurological consequence of massive wasp stings[J]. BMJ Case Rep,2012,28(7):2012.
[15] Moein P,Zand R. Cerebral Infarction as a Rare Complication of Wasp Sting[J]. J Vasc Interv Neurol,2017,9(4):13-16.
[16] Anandan PK,Hanumanthappa NB,Bhatt P,et al. Allergic angina following wasp sting:Kounis syndrome[J]. Oxf Med Case Reports,2015,2015(6):306-308.
[17] Gawlik R,Pezold M,Bozek A. Non-ST-elevation myocardial infarction after a wasp sting[J]. Postepy Dermatol Alergol,2014,31(4):266-268.
[18] Nittner-Marszalska M,Kopec A,Biegus M,et al. Non-ST segment elevation myocardial infarction after multiple bee stings.A case of"delayed"Kounis II syndrome?[J]. Int J Cardiol,2013,166(3):e62-e65.
[19] Sharma M,Das HJ,Barman AK,et al. Acute kidney injury due to multiple wasp stings[J]. Saudi J Kidney Dis Transpl,2017,28(1):196-198.
[20] Wenjie W,Houqing L,Gengyun S. Rhabdomyolys is owing to a wasp sting[J]. Clin Exp Pharmacol Physiol,2015,42(7):808-809.
[21] Vikrant S,Parashar A. Two Cases of Acute Kidney Injury Due to Multiple Wasp Stings[J]. Wilderness Environ Med,2017,28(3):249-252.
[22] Kang W,Zhang J,Xie Y,et al. Spontaneous splenic rupture:an unusual complication following wasp stings[J]. ANZ J Surg,2017,87(4):315-316.
[23] Das SK,Zeng LC,Li B,et al. Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome:A case report[J]. World J Radiol,2014,6(9):737-740.
[24] Ruiz OA,Mikkelsen S,Bindslev-Jensen C,et al. Pre-hospital treatment of bee and wasp induced anaphylactic reactions:a retrospective study[J]. Scand J Trauma Resusc Emerg Med,2017,25(1):4.
[25] Oppenheimer J,Golden D. Hymenoptera venom immunotherapy:Past,present,and future[J]. Ann Allergy Asthma Immunol,2018,121(3):276-277.
[26] Golden DB,Kelly D,Hamilton RG,et al. Venom immunotherapy reduces large local reactions to insect stings[J]. J Allergy Clin Immunol,2009,123(6):1371-1375.
[27] Sacha M,Czarnobilska E,Stobiecki M,et al. Influence of venom immunotherapy on anxiety level of being re-stung[J].Przegl Lek,2012,69(12):1261-1265.
[28] Diwakar L,Ewan P,Huber PA,et al. The impact of national guidelines on venom immunotherapy practice in the United Kingdom[J]. Clin Exp Allergy,2016,46(5):749-753.
[29] Palgan K,Bartuzi Z,Gotz-Zbikowska M. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting[J]. Int J Immunopathol Pharmacol,2014,27(1):109-112.
[30] Bilo BM,Bonifazi F. Advances in hymenoptera venom immunotherapy[J]. Curr Opin Allergy Clin Immunol,2007,7(6):567-573.
[31] Golden D. Rush Venom Immunotherapy:Ready for Prime Time?[J]. J Allergy Clin Immunol Pract,2017,5(3):804-805.
[32] Golden DB. Long-term outcome after venom immunotherapy[J]. Curr Opin Allergy Clin Immunol,2010,10(4):337-341.
[33] Dhanapriya J,Dineshkumar T,Sakthirajan R,et al. Wasp sting-induced acute kidney injury[J]. Clin Kidney J,2016,9(2):201-204.
[34] Kumar V,Nada R,Kumar S,et al. Acute kidney injury due to acute cortical necrosis following a single wasp sting[J]. Ren Fail,2013,35(1):170-172.
[35] Hu J,Wang Y,Geng X,et al. Metabolic acidosis as a risk factor for the development of acute kidney injury and hospital mortality[J]. Exp Ther Med,2017,13(5):2362-2374.
[36] Vanmassenhove J,Kielstein J,Jorres A,et al. Management of patients at risk of acute kidney injury[J]. Lancet,2017,389(10084):2139-2151.
[37] Digvijay K,Neri M,Fan W,et al. International Survey on the Management of Acute Kidney Injury and Continuous Renal Replacement Therapies:Year 2018[J]. Blood Purif,2018,47(3):113-119.
[38] Xie C,Xu S,Ding F,et al. Clinical features of severe wasp sting patients with dominantly toxic reaction:analysis of 1091cases[J]. PLOS One,2013,8(12):e83164.
[39] Si X,Li J,Bi X,et al. Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome[J]. PLOS One,2015,10(7):e132708.
[40] Yuan H,Chen S,Hu F,et al. Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings[J]. Blood Purif,2016,42(1):49-55.
[2] Akyildiz B,Ozsoylu S,Ozturk MA,et al. A fatal case caused by massive honey bee stings[J]. Turk J Pediatr,2015,57(6):611-614.
[3] Chen L,Huang G Z. Poisoning by toxic animals in China--18autopsy case studies and a comprehensive literature review[J].Forensic Sci Int,2013,232(1-3):e12-e23.
[4] Montagni M,Peveri S,Incorvaia C,et al. Scoliid Wasp Sting:A New Cause of Anaphylaxis[J]. J Investig Allergol Clin Immunol,2017,27(5):331-333.
[5] Galvez-Olortegui J,Alvarez-Vargas M,Durand-Vergara J,et al. Henoch Schonlein purpura associated with bee sting:case report[J]. Medwave,2015,15(9):e6297.
[6] Hon KL,Leung A. Bee or Wasp Sting[J]. Wounds,2017,29(9):E70-E72.
[7] Lai P,Yang J,Cui H,et al. Prognosis of corneal wasp sting:case report and review of the literature[J]. Cutan Ocul Toxicol,2011,30(4):325-327.
[8] Im JC,Kang YK,Park TI,et al. Sympathetic Ophthalmia after Ocular Wasp Sting[J]. Korean J Ophthalmol, 2015, 29(6):435-436.
[9] Gortzak K,Gortzak RA. Wasp and bee stings[J]. Ned Tijdschr Tandheelkd,2013,120(7-8):373-376.
[10] Nag SS,Ghosh N,Singh AK,et al. Nephritic syndrome following multiple bee stings:a late hypersensitivity reaction[J]. Paediatr Int Child Health,2015,35(2):157-159.
[11] Korosec P,Gibbs BF,Rijavec M,et al. Important and specific role for basophils in acute allergic reactions[J]. Clin Exp Allergy,2018,48(5):502-512.
[12] Casale TB,Burks AW. Clinical practice. Hymenoptera-sting hypersensitivity[J]. N Engl J Med,2014,370(15):1432-1439.
[13] Arslan M,Gungor A,Akin O,et al. A rare complication of wasp sting:acute cervical dystonia[J]. Childs Nerv Syst,2015,31(12):2213-2214.
[14] Volders J,Smits M,Folkersma G,et al. An unusual neurological consequence of massive wasp stings[J]. BMJ Case Rep,2012,28(7):2012.
[15] Moein P,Zand R. Cerebral Infarction as a Rare Complication of Wasp Sting[J]. J Vasc Interv Neurol,2017,9(4):13-16.
[16] Anandan PK,Hanumanthappa NB,Bhatt P,et al. Allergic angina following wasp sting:Kounis syndrome[J]. Oxf Med Case Reports,2015,2015(6):306-308.
[17] Gawlik R,Pezold M,Bozek A. Non-ST-elevation myocardial infarction after a wasp sting[J]. Postepy Dermatol Alergol,2014,31(4):266-268.
[18] Nittner-Marszalska M,Kopec A,Biegus M,et al. Non-ST segment elevation myocardial infarction after multiple bee stings.A case of"delayed"Kounis II syndrome?[J]. Int J Cardiol,2013,166(3):e62-e65.
[19] Sharma M,Das HJ,Barman AK,et al. Acute kidney injury due to multiple wasp stings[J]. Saudi J Kidney Dis Transpl,2017,28(1):196-198.
[20] Wenjie W,Houqing L,Gengyun S. Rhabdomyolys is owing to a wasp sting[J]. Clin Exp Pharmacol Physiol,2015,42(7):808-809.
[21] Vikrant S,Parashar A. Two Cases of Acute Kidney Injury Due to Multiple Wasp Stings[J]. Wilderness Environ Med,2017,28(3):249-252.
[22] Kang W,Zhang J,Xie Y,et al. Spontaneous splenic rupture:an unusual complication following wasp stings[J]. ANZ J Surg,2017,87(4):315-316.
[23] Das SK,Zeng LC,Li B,et al. Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome:A case report[J]. World J Radiol,2014,6(9):737-740.
[24] Ruiz OA,Mikkelsen S,Bindslev-Jensen C,et al. Pre-hospital treatment of bee and wasp induced anaphylactic reactions:a retrospective study[J]. Scand J Trauma Resusc Emerg Med,2017,25(1):4.
[25] Oppenheimer J,Golden D. Hymenoptera venom immunotherapy:Past,present,and future[J]. Ann Allergy Asthma Immunol,2018,121(3):276-277.
[26] Golden DB,Kelly D,Hamilton RG,et al. Venom immunotherapy reduces large local reactions to insect stings[J]. J Allergy Clin Immunol,2009,123(6):1371-1375.
[27] Sacha M,Czarnobilska E,Stobiecki M,et al. Influence of venom immunotherapy on anxiety level of being re-stung[J].Przegl Lek,2012,69(12):1261-1265.
[28] Diwakar L,Ewan P,Huber PA,et al. The impact of national guidelines on venom immunotherapy practice in the United Kingdom[J]. Clin Exp Allergy,2016,46(5):749-753.
[29] Palgan K,Bartuzi Z,Gotz-Zbikowska M. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting[J]. Int J Immunopathol Pharmacol,2014,27(1):109-112.
[30] Bilo BM,Bonifazi F. Advances in hymenoptera venom immunotherapy[J]. Curr Opin Allergy Clin Immunol,2007,7(6):567-573.
[31] Golden D. Rush Venom Immunotherapy:Ready for Prime Time?[J]. J Allergy Clin Immunol Pract,2017,5(3):804-805.
[32] Golden DB. Long-term outcome after venom immunotherapy[J]. Curr Opin Allergy Clin Immunol,2010,10(4):337-341.
[33] Dhanapriya J,Dineshkumar T,Sakthirajan R,et al. Wasp sting-induced acute kidney injury[J]. Clin Kidney J,2016,9(2):201-204.
[34] Kumar V,Nada R,Kumar S,et al. Acute kidney injury due to acute cortical necrosis following a single wasp sting[J]. Ren Fail,2013,35(1):170-172.
[35] Hu J,Wang Y,Geng X,et al. Metabolic acidosis as a risk factor for the development of acute kidney injury and hospital mortality[J]. Exp Ther Med,2017,13(5):2362-2374.
[36] Vanmassenhove J,Kielstein J,Jorres A,et al. Management of patients at risk of acute kidney injury[J]. Lancet,2017,389(10084):2139-2151.
[37] Digvijay K,Neri M,Fan W,et al. International Survey on the Management of Acute Kidney Injury and Continuous Renal Replacement Therapies:Year 2018[J]. Blood Purif,2018,47(3):113-119.
[38] Xie C,Xu S,Ding F,et al. Clinical features of severe wasp sting patients with dominantly toxic reaction:analysis of 1091cases[J]. PLOS One,2013,8(12):e83164.
[39] Si X,Li J,Bi X,et al. Clinical Evaluation of High-Volume Hemofiltration with Hemoperfusion Followed by Intermittent Hemodialysis in the Treatment of Acute Wasp Stings Complicated by Multiple Organ Dysfunction Syndrome[J]. PLOS One,2015,10(7):e132708.
[40] Yuan H,Chen S,Hu F,et al. Efficacy of Two Combinations of Blood Purification Techniques for the Treatment of Multiple Organ Failure Induced by Wasp Stings[J]. Blood Purif,2016,42(1):49-55.