山东省恙虫病的实验室诊断

本实验室以从联合国引进的各群立克次体标准株为参考株,采用免疫荧光和免疫酶标记染色方法,结合病原体的检查,证实了1986年9～12月山东省恙虫病的流行.免疫荧光和免疫酶标染色检测10例可疑恙虫病人血清的恙虫病立克次体抗体,阳性率90%,IgG抗体滴度为2560～5120,IgM抗体滴度为2560～20480,高于IgG抗体滴度,且可在病人静脉血感染的小鼠脏器涂片中查见立克次体.     

广东地区严重急性呼吸综合征患者血清学调查

目的 通过调查严重急性呼吸综合征(SARS)患者血清中特异IgG、IgM抗体，找出冠状病毒与SARS之间可能存在的病因关糸；比较急性期和恢复期血清抗体效价，寻求该病毒特有的血清学反应及其临床意义。方法 用新分离SARS病毒作为抗原，采用间接免疫荧光(IFA)和酶联免疫吸附试验(ELISA)法，对广州4所医院SARS病人的血清标本进行检测。结果 检测临床诊断SARS病人130例，其中117例出现病毒特异性抗体，阳性率达90%，病人血清IgG抗体滴度10天后明显上升，15天后抗体达到高峰，IgM抗体滴度20～30天达到高峰。检测119例健康接触者和同一流行区100例健康人，结果全部为阴性。结论 SARS病人血清与新分离SARS病毒抗原有高水平的特异反应，证实病人急性感染了这种新的病毒；病人恢复期血清IgG抗体在体内滴度高、持续时间长，提示可能是人群保护性抗体。     

唾液中抗流行性出血热病毒IgM的诊断评价

本文采用亲和层析纯化的羊抗人 IgMu 链抗体为包被抗体的抗体捕捉 ELISA 法,从流行性出血热病毒(EHF)感染的重型、危重型患者血清和唾液中测定抗流行性出血热病毒 IgM(抗 EHF—IgM),进行对比观察,以探讨唾液标本在 EHF 诊断上的意义。检测结果:28例 EHF 患者唾液中检出抗 EHF—IgM 者26例,符合率92.86%,在15～20病日 IgM 抗体滴度逐渐下降,22病日后唾液 IgM 呈阴性。结果提示:唾液中抗EHF—IgM 高峰在病程早中期(1—14病日),只要采样时机合适即可获得高的抗 EHF—IgM 阳性率。     

山西省恙虫病调查与病原学研究

目的：１９９５年山西晋南地区发生恙虫病流行，我们对该地区人群进行了流行病学调查；并对从患者和野鼠体内分离的恙虫病立克次体进行了病原学研究。方法：利用微量间接免疫荧光法（ＭＩＦ）对恙虫病立克次体在人群中的流行进行了调查；采用ＭＩＦ、ＰＣＲ／ＲＦＬＰ和序列分析方法对恙虫病立克次体分离株进行了鉴定。结果和结论：晋南地区人民群血清恙虫病立克次体抗体阳性率为２５％；恙虫病立克次体山西分离株（Ｓｘｈ９５１，Ｓｘｈ９５２，Ｓｘｈ９５３，Ｓｘｍ９７）的血清型别为Ｇｉｌｌｉａｍ株；序列分析提示：在相对分郭质量５６０００蛋白基因水平上，Ｓｘｈ９５１株与Ｙｏｎｇｃｈｏｎ株亲缘关系最近。     

SARS 25例临床诊断患者血浆特异性抗体和病毒的动态检测

目的 动态检测SARS患者血浆特异性IgM和IgG以及SARS冠状病毒(SARS-CoV)的变化规律。方法 用酶联吸附免疫法对25例145份SARS临床诊断患者血浆特异性IgM和IgG进行定性检测,用RT-PCR对其中114份血浆进行SARS-CoV定性检测。结果 IgM和IgG抗体的阳性样本检出率分别为49．0％(71／145)和54．5％(79／145),阳性患者检出率均为84．0％(21／25),两种抗体大多在发病第2～4周产生,前5周检出率相近,均呈上升趋势,以后IgM抗体检出率开始下降,IgG抗体检出率则继续上升。血浆SAPS-CoV阳性样本检出率为15．8％(18／114),阳性患者检出率为40．0％(10／25),多为发病后4周内采集的样本,抗体检测阴性或初次阳性。结论 血浆特异性抗体以及SARS-CoV检测可作为SARS的确诊依据;抗体产生后大多数病人血浆病毒很快转阴,但有个别病人在抗体产生2～3周后仍能在血浆中检测到病毒序列。     

某部急性上呼吸道感染暴发疫情的病原学检测

目的 通过实验室病原学筛查,结合流行病学史及临床表现,初步筛查某部急性上呼吸道感染暴发疫情的致病病原体.方法 采集51例患者血液和咽拭子标本,分别采用免疫荧光、酶联免疫吸附试验(ELISA)、聚合酶链反应(PCR)、病毒分离及微生物学细菌培养等实验室诊断方法筛查、确定致病病原体,并对15例恢复期患者(发病后15～28d)血清进行IgG滴度检测,比较急性期与恢复期抗体滴度的变化.结果 所有咽拭子的细菌培养及7例咽拭子的病毒分离试验结果均为阴性.对24例患者血清进行的免疫荧光法呼吸道常见20种病原体IgM抗体筛查结果显示:流感A型阳性率为20.8%(5/24),流感B型阳性率为12.5%(3/24),肺炎衣原体阳性率为20.8%(5/24),肺炎支原体阳件率为50.0%(12/24),其余病原体检测均为阴性.ELISA检测IgM抗体结果显示:总流感病毒IgM抗体阳性2例(3.92%),肺炎衣原体抗体阳性7例(13.7%),肺炎支原体抗体阳性20例(39.2%),呼吸道合胞病毒抗体阳性2例(3.92%),EB病毒抗体阳性1例(1.96%).免疫荧光法肺炎支原体IgG抗体滴度检测结果显示1:100稀释后阳性反应37例(72.5%),其中的31例(60.8%)在1:1000稀释后仍呈阳性反应,对照组仪2例(6.45%)IgG抗体1:100时呈阳性,在1:1000稀释后均为阴性.PCR实验未见特异扩增反应.恢复期与急性期血清抗体效价检测发现15例中有7例肺炎支原体抗体效价有4倍以上变化.结论 初步推断此次某部群体急性上呼吸道感染事件系肺炎支原体感染引起;该疫情的实验室快速诊断为今后疫情的早期诊断提供了思路.     

高原地区中药治疗ABO血型不合的临床研究

目的：探讨青海高原地区ABO母儿血型不合的发病特点,并通过孕期中药治疗,观察血清抗体滴度的变化和对新生儿溶血病的影响,为中药治疗的有效性提供临床依据。方法：对100例ABO血型不合的患者进行抗体滴度检测,并给予中药治疗,观察中药治疗后抗体滴度的变化及新生儿发生溶血病的发病率,观察用药时间长短与抗体滴度变化的关系,抗体滴度与分娩孕周的关系,观察分娩结局。结果：中药治疗对血型不合患者的早产率有降低作用;中药治疗后新生儿溶血发生明显降低,新生儿死亡率下降。中药治疗时间越长,抗体滴度下降效果越好,溶血发生率越低。结论：高原地区ABO母儿血型不合溶血病的发病率为2.4%,中药治疗有效率为86%,中药治疗可降低血清抗体滴度水平,降低溶血病的发病率,减轻病变程度,治疗效果与治疗时间成正相关,早期中药干预治疗对提高分娩结局有良好作用。     

北京市房山区甲型H1N1流感抗体血清流行病学调查

 目的 了解北京市房山区人群甲型H1N1流感免疫水平,为完善该区甲型H1N1流感疫情防控措施提供科学依据.方法 选择房山区常住人口784名,按照年龄组进行分层和问卷调查,采集血清标本进行甲型H1N1流感病毒血凝抑制(hemagglutination-inhibition,HI)抗体检测,比较不同人群甲型H1N1流感保护性抗体阳性率和抗体几何平均滴度(geometric mean titer,GMT).结果 784名调查对象甲型H1N1抗体阳性率为40.9%(321/784),抗体几何平均滴度为1∶ 18.39.6~15岁年龄组抗体阳性率最高(57.5%),其次是16~24岁年龄组(54.7%),而≥60岁年龄组HI抗体阳性率最低(21.2%).非条件多因素logistic回归分析显示,年龄及接种甲型H1N1流感疫苗与HI抗体阳性呈显著性相关.结论 房山区有超过40%的人群具有甲型H1N1流感保护性抗体,普通人群中已经建立一定的免疫屏障.     

不明原因呼吸道感染疫情病原学分析

目的 对某部营区内的群发上呼吸道感染进行病因学研究,以明确诊断,控制并预防疫情扩散.方法 采集32例住院患者的血清和咽拭子标本,其中4例有急件期及恢复期双份血清.血清标本采用欧蒙间接免疫荧光法(IFA)和ELISA法进行20种呼吸道相关病原IgM抗体筛查,双份血清进行滴度比较;咽拭子标本进行病毒分离培养和细菌培养.依据血清学结果对咽拭子进行相关病原DNA的提取、扩增及测序分析.结果 血清ELISA检测结果显示32例患者中腺病毒IgM阳性12例,肺炎衣原体IgM阳性15例.TFA检测结果显示肺炎衣原体kM阳性17例,肺炎支原体、流感A病毒、副流感病毒IgM阳性各1例.4例双份血清中肺炎衣原体和腺病毒IgM各有2例滴度呈4倍变化.细菌培养及病毒分离培养均阴性.1例高热患者咽拭子标本3对腺病毒相关引物PCR呈阳性,测序显示为腺病毒11型.采用大环内酯类抗生素进行治疗,大部分病例有效.结论 结合临床特征及病原学分析结果,判断此次疫情的原因主要为腺病毒及肺炎衣原体的合并或交替感染.     

育龄女性优生五项(TORCH)IgM抗体检测对优生优育的意义研究

目的 探讨育龄女性进行优生五项(TORCH)IgM抗体检测对优生优育的意义.方法 选取2019年1月～2020年6月接受优生五项检查的450例育龄女性为研究对象,对弓形虫病毒(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)、单纯疱疹病毒Ⅰ(HSVⅠ)、单纯疱疹病毒Ⅱ(HSVⅡ)进行IgM抗体检测,对比其的阳性率与在不同年龄女性间的分布情况.结果 在TORCH-IgM检测结果 中,CMV-IgM的阳性检出率最高,HSVⅠ-IgM与TOX-IgM 检出率最低;20～29岁之间的育龄女性 TOX-IgM、RV-IgM、CMV-IgM、HSV Ⅰ-IgM、HSVⅡ-IgM检测结果 与其他年龄段女性相比有明显差异(P＜0.05).结论 育龄女性TORCH-IgM抗体检测能够及时对TORCH进行明确诊断,减少不良妊娠发生情况,为优生优育提供了强有力的依据.     

Scrub typhus: radiological and clinical findings

OBJECTIVES: To describe the radiological and clinical findings of scrub typhus. We retrospectively analysed the radiographic, thin-section CT and clinical features of scrub typhus. METHODS: The study included 75 consecutive patients (median age = 47 years, range = 18-81 years) with scrub typhus. Plain chest radiographs were obtained in all 75 patients and 19 underwent thin-section CT within 6 days of initial radiography. The radiographic and thin-section CT findings were retrospectively analysed by three radiologists. RESULTS: Most common clinical symptoms were fever (73/75, 98%), myalgia (61/75, 81%) and headache (60/75%, 80%). Rash (59/75, 79%) and eschar (56/75, 75%) were the most common signs. Radiography showed abnormalities in 54/75 (72%) patients. The most frequent findings were parenchymal abnormalities (53/75, 71%) with lower lung predilection including bilateral reticulonodular opacities (30/75, 40%), ground-glass opacity (19/75, 25%), consolidation (19/75, 25%), septal lines (27/75, 36%) and hilar lymph node enlargement (19/75, 25%). Thin-section CT (n = 19) showed ground-glass opacity (17/19, 89%) predominantly in the lower zones. Bronchial wall thickening (11/19, 58%), centrilobular nodules (9/19, 47%) and interlobular septal thickening (9/19, 47%) were less frequent findings. CONCLUSIONS: Scrub typhus is an acute febrile illness characterized by eschar, which usually has a limited course without serious complication. Diffuse bilateral reticulonodular opacities with lower lung predominance was the most frequent radiographic finding. Chest radiography and thin-section CT show pulmonary interstitial disease which may have a component of pulmonary oedema secondary to cardiac dysfunction.     

在健康人群抗体监测结果分析指导下开展防疫工作──197例白喉及麻疹抗体水平监测结果分析

１９８９年～１９９０年丰台区发生白喉暴发流行，１９９１年东高地地区发生３例成人麻疹，提示我们进行健康人群血清抗体监测，以科学地指导防疫工作。我处于１９９１年１０月随机抽取２～３９岁健康人群１９７名，进行白喉、麻疹抗体水平监测，监测结果显示：白喉抗体阳性率９５．４３％，比１９９０年北京市监测结果（８７．３０）高出８．１３％，ＧｍＴ０．２５５６Ｉｕ／ｍｌ，比１９９０年北京市监测结果０．１２５Ｉｕ／ｍｌ提高０．１３０６Ｉｕ／ｍｌ。麻疹ＨＩ抗体阳性率９８．５％，其中高抗率６６．５％，ＧｍＴ在１：４５．２５８７～１：２０．１５８７之间。加强免疫后一年免疫抗体逐渐下降，维持在１：２０～１：６．３４９６之间。通过监测，我院对抗体阴性及低抗人群及时补菌，致使１９９２～１９９３年无相应疫情发生。预计近几年在我院将可控制白喉、麻疹多发生暴发疫情。     

Xerostomia in a patient with scrub typhus

Scrub typhus is an acute febrile disease caused by the intracellular organism Orientia tsutsugamushi. The main pathogenesis is focal or disseminated multi-organ vasculitis caused by the infection of endothelial cells and the perivascular infiltration of leukocytes. Many studies have reported interstitial pneumonia, cholecystitis, pancreatitis, and meningoencephalitis in scrub typhus. However, there is no report about sialoadenitis in a patient with scrub typhus. A 79-year-old man was admitted to the emergency room due to a high fever, headache, and myalgia. Scrub typhus was confirmed based on the indirect immunofluorescence assay and the nested polymerase chain reaction. He suffered from severe dry mouth and underwent Tc-99m pertechnetate salivary scintigraphy. While the radiopharmeceutical uptake of the bilateral parotid and submandibular glands was within normal range, salivary excretion into the oral cavity was markedly decreased. After the proper antibiotic treatment, salivary scintigraphy was performed again. Radioactivity in the oral cavity was increased and the ejection fraction (%) after using sialogogue was also improved to the normal range. As far as we know, this is the first report to show salivary scintigraphy of a patient with scrub typhus. By using a Tc-99m pertechnetate salivary scintigraphy, we found that the excretory function of salivary glands was markedly decreased, while the uptake ability was preserved in scrub typhus, unlike Sjögren''s syndrome and radiation-induced xerostomia. Salivary scintigraphy presents dry mouth objectively and provides quantitative values as well. Salivary scintigraphy could contribute to the assessment of sialoadenitis before and after treatment of scrub typhus.     

双重血浆置换在ABO血型不合肝移植中的疗效观察

 目的 探讨双重血浆置换在ABO 血型不合肝移植中的治疗效果。方法 20例ABO血型不合的肝移植患者,随机分为双重血浆置换组(治疗组)和对照组,观察两组治疗3周后临床症状、并发症发生情况、肝功能生化指标的变化等,随访治疗后3个月内病情转归情况并分析影响疗效的因素。结果 经过双重血浆置换治疗24 h后,5例患者受体术前血型抗体滴度为1∶32,术后24 h内稳定在1∶8;3例患者受体术前血型抗体滴度为1∶4, 术后7 d内稳定在1∶2;2例患者受体术前1∶16,术后2～3个月开始反弹后又自行下降并稳定在1∶8。根据整体疗效而言,治疗组有效率达80.0%,对照组有效率为40.0%,治疗组明显高于对照组(P<0.05)。结论 双重血浆置换是一种治疗血型不合肝移植有效、可靠的技术手段,使得术后患者的生存质量得到改善。     

Scrub typhus: radiological and clinical findings in abdominopelvic involvement

Purpose

To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus.

Materials and methods

Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Patients were divided into four clinical subgroups according to laboratory findings. Association between imaging findings and subgroups was analyzed by Chi squared test or Fisher’s exact test.

Results

The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). Pelvic lymphadenopathy was most commonly seen when eschar was found in the ipsilateral lower extremity (left, n = 5/7; right, n = 8/13). Significant association between hepatic dysfunction and perigastric lymphadenopathy was documented (p = 0.03).

Conclusion

Scrub typhus has a spectrum of variable clinical and radiological findings mimicking those of acute hepatitis. Diffuse abdominopelvic lymphadenopathy involving the retroperitoneum and pelvic area may aid in early diagnosis of scrub typhus. Perigastric lymphadenopathy could be a sign of severe scrub typhus combined with hepatic dysfunction.