急性心肌梗死与柯萨奇B组病毒感染关系的研究

目的　探讨柯萨奇B组病毒感染与急性心肌梗死 (AMI)的发病关系。方法　应用SPA吸收IgG结合间接ELISA法检测AMI患者血清中柯萨奇B组病毒特异性IgM抗体及中和抗体。结果　 4 8例AMI患者血清特异性IgM抗体阳性率为 75 % ,血清中和抗体阳性率为 85 4 % ,与正常对照组相比差异非常显著。双份血清试验 ,恢复期血清抗体效价高于初期血清抗体效价 4倍以上。结论　AMI发病与柯萨奇B组病毒感染有关。     

骨科术后大量输血患者巨细胞病毒活动性感染与血清IgM,IgA水平变化

目的 研究骨科术后大量输血患者巨细胞病毒(cytomegalovirus,CMV)活动性感染时血清IgM和IgA水平变化及其意义.方法 应用速率散射比浊法分别检测武警北京总队第二医院86例骨科术后大量输血患者巨细胞病毒活动性感染组与非活动性感染组血清IgM和IgA水平变化,结果进行方差分析.结果 86例骨科术后大量输血患者中21例巨细胞病毒活动性感染组血清IgM和IgA的水平明显高于65例输血后无活动性感染组(P＜0.05),而与对照组40例骨科术后未输血患者比较差异无统计学显著性意义(P＞0.05).结论 骨科术后大量输血患者巨细胞病毒活动性感染时,免疫系统处于激活状态,而激活的免疫系统参与了大量输血后巨细胞病毒活化引起的免疫反应.     

227例肾移植患者巨细胞病毒抗体检测分析

目的通过对北京军区北戴河疗养院肾移植患者进行血清巨细胞病毒抗体的测定,了解肾移植患者巨细胞病毒感染情况。方法运用ELISA方法对227例肾移植患者巨细胞病毒抗体IgG和IgM做定性检测。结果 227例患者中巨细胞病毒抗体IgM阳性率为33.92%,其中1个月内感染率为6.17%,1～2个月感染率为4.41%,2～4个月感染率为10.57%,4个月～1年感染率为7.05%,移植后4个月内感染发生率为21.15%,1年以上感染率为5.73%。结论巨细胞病毒感染在移植后4个月内感染率最高,ELISA方法虽简单,但在早期诊断上有局限性。     

肝移植术后巨细胞病毒感染的特点

目的:观察肝移植受者术后巨细胞病毒的感染情况及干预效果。方法:选择2002-07/2005-07在上海交通大学医学院附属新华医院行同种异体原位肝移植手术的患者20例,均知情同意。术后1个月内每周检测1次巨细胞病毒血清抗体,术后2~6个月每个月检测1次巨细胞病毒血清抗体,以后有感染症状时检测巨细胞病毒血清抗体。所有患者术后给予更昔洛韦0.5g静脉滴注,2次/d,维持2周;以后用阿昔洛韦800mg/d口服,维持3个月进行预防性治疗。所有患者术后采用三联免疫抑制治疗,根据术后血药浓度及肝功能改变调整免疫抑制药物用量。采用ELISA法检测患者血中巨细胞病毒抗体-巨细胞病毒IgG、巨细胞病毒IgM。巨细胞病毒血清抗体阳性者诊断为巨细胞病毒感染;巨细胞病毒血清抗体阳性合并组织器官受累者诊断为巨细胞病毒病。结果:20例患者全部进入结果分析,无脱落。20例患者中3例血中巨细胞病毒IgM转化为阳性,为巨细胞病毒感染,其中2例伴有呼吸系统症状及影像学改变,诊断为巨细胞病毒性肺炎。3例巨细胞病毒感染病例中2例治愈,1例死于呼吸衰竭。巨细胞病毒感染率为15%(3/20),巨细胞病毒肺炎发病率为10%(2/20),病死率为5%(1/20)。结论:肝移植术后进行巨细胞病毒感染的预防性治疗,定时监测尽早发现巨细胞病毒感染,及时治疗,阻断其向巨细胞病毒病演变是降低巨细胞病毒病死率的有效方法。     

巨细胞病毒感染引起免疫功能低下16例临床分析

要2002年1月～2003年6月在我院住院的16例巨细胞病毒感染患儿IgA、IgM、IgG检测结果显示均有IgA、IgM、IgG降低，考虑存在免疫功能低下，均伴有2个以上器官、系统的损害，巨细胞病毒肺炎多迁延难愈，加用丙种球蛋白治疗，效果常较好。     

亚高原地区急性心肌梗死患者体液免疫变化的临床研究

目的探讨亚高原地区急性心肌梗死(AMI)患者体液免疫变化及其临床意义。方法 52例AMI患者(AMI组)分别在胸痛发作6h以内、72h、7d、15d、21d、30d检测血清IgG、IgA、IgM水平并与50例健康对照组进行对比分析。结果 AMI组胸痛发作6h以内血清IgG、IgA、IgM水平与健康对照组比较差异无统计学意义(P>0.05);胸痛发作72h血清IgG、IgA、IgM水平开始升高;胸痛发作第7天,血清IgG、IgA水平明显升高,与健康对照组比较差异有统计学意义(P<0.01),且持续升高至15d;第21天血清IgG、IgA水平开始下降,30d后血清IgG、IgA基本恢复正常水平,与健康对照组比较差异无统计学意义(P>0.05)。结论亚高原地区AMI患者早期免疫功能处于抑制状态,体液免疫功能紊乱,持续时间长。AMI患者免疫功能变化与病情转归有密切关系,动态观察免疫球蛋白含量变化,可作为AMI病情观察的动态指标。     

格林-巴利综合征患者神经系统感染病毒抗体谱分析

目的了解格林-巴利综合征(GBS)患者的神经系统病毒抗体谱分布特征,探讨GBS与病毒感染之间的关系。方法对首都医科大学附属北京天坛医院2013-2017年确诊为GBS的54例患者的血清及脑脊液进行神经系统感染病毒抗体检测,从性别、年龄、急慢性等方面对病毒抗体阳性率进行分析。结果 54例GBS患者血清和脑脊液中不同抗体的检出率存在较大差异,其中巨细胞病毒-免疫球蛋白G(CMV-IgG)抗体在血清及脑脊液中的检出率(98.1%、68.5%)最高。血清中检测到单纯疱疹病毒(HSV)1+2IgM抗体阳性2例,脑脊液中检测到HSV1+2IgM抗体阳性1例(其中1例为血清和脑脊液双阳性),血清中检测到EB病毒早期抗原(EBEA)-IgM阳性1例。GBS急性组患者血清风疹病毒(RUB)IgG抗体和弓形虫(TOX)IgG抗体阳性率(92.5%、37.5%)显著高于GBS慢性组患者(71.4%、7.1%),差异均有统计学意义(P0.05)。结论 HSV和EB病毒可能与GBS的发病具有相关性。相较于慢性GBS,RUB和TOX前驱感染可能与急性GBS更具有相关性,但仍需进一步相关研究证实。     

神经梅毒患者血清及脑脊液免疫学指标诊断特征分析

目的探讨神经梅毒患者血清及脑脊液免疫学诊断特点。 方法选取2013年6月至2016年7月首都医科大学附属宣武医院收治的35例神经梅毒患者,其中32例患者行血清与脑脊液免疫学指标检测,回顾性分析35例患者的检查结果,应用Fisher精确检验比较血清组与脑脊液组IgA、IgM的差异,应用卡方检验比较血清组与脑脊液组IgG的差异,并对脑脊液寡克隆条带阳性检出率和脑脊液24 h IgG合成率进行分析。 结果32例神经梅毒患者检测血清免疫球蛋白,有53.13%(17/32)的患者IgG升高,6.25%(2/32)的患者IgA升高,0%(0/32)的患者IgM升高;脑脊液中,有84.38%(27/32)的患者IgG升高,100.00%(32/32)的患者IgA升高,90.63%(29/32)的患者IgM升高;血清与脑脊液IgA、IgM升高率比较,差异有统计学意义(P<0.01),IgG升高率比较,差异无统计学意义(χ²＝7.27,P>0.05)。25例神经梅毒患者行CSF寡克隆电泳,IgG寡克隆条带阳性率为100.00%(25/25),96.00%(24/25)患者脑脊液24 h IgG合成率升高。 结论神经梅毒临床表现多样,是易误诊的可治性疾病。血清及脑脊液IgG多表现为升高,脑脊液IgA、IgM多表现为升高而血清IgA、IgM多表现为正常,脑脊液寡克隆条带阳性,脑脊液24 h IgG合成率升高等免疫学特点对神经梅毒诊断有意义。     

山东地区0～12岁儿童人巨细胞病毒抗体阳性特征分析

目的分析山东地区0~12岁儿童人巨细胞病毒抗体的阳性特征。方法收集2014年1月至2016年12月在山东大学附属省立医院门诊就诊和住院的儿童患者1 429例。用化学发光方法检测血清人巨细胞病毒IgG和IgM抗体。用SPSS21.0软件进行统计分析。结果巨细胞病毒IgG抗体和IgM抗体阳性率分别为89.36%和16.59%,男性巨细胞病毒IgG抗体阳性率为88.04%,明显低于女性的91.32%(P0.05)。男性巨细胞病毒IgM抗体阳性率为14.07%,明显低于女性的20.31%(P0.05)。巨细胞病毒IgG抗体阳性率以6~12个月年龄组最低(73.68%),0~6个月年龄组最高(92.73%);巨细胞病毒IgM抗体阳性率以4~12岁年龄组最低(10.26%),1~3岁年龄组最高(21.57%)。巨细胞病毒IgM抗体阳性率冬季最高为22.92%,秋季阳性率最低为11.11%,四个季节之间阳性率差异有统计学意义(P0.05)。共检出4种巨细胞病毒抗体项目组合模式,以巨细胞病毒IgG抗体阳性、巨细胞病毒IgM抗体双阴性模式最多见,占73.27%。结论山东地区0~12岁儿童人巨细胞病毒抗体的阳性率存在性别、年龄和季节差异,应加强对儿童人巨细胞病毒感染的防控。     

更昔洛韦对原位肝移植术后巨细胞病毒感染的预防和治疗:19例临床资料回顾

目的:巨细胞病毒感染是器官移植后的一个严重并发症,回顾性分析肝移植术后患者巨细胞病毒感染的诊断和防治方法.方法:①回顾分析2005-05/2006-08解放军总医院第二附属医院全军器官移植中心收治的19例肝移植受者的临床资料,供者均为健康献肝者.供者、受者对治疗方案均知情同意,且得到医院伦理道德委员会批准.②术后1个月检测1次巨细胞病毒血清抗体,预防和治疗巨细胞病毒感染均采用静脉注射更昔洛韦.术后采用三联免疫抑制疗法,根据术后血药浓度及肝功能改变调整免疫抑制药物用量.③采用酶联免疫吸附法检测患者血中巨细胞病毒抗体巨细胞病毒IgG、巨细胞病毒IgM.结果:19例受者中6例发生巨细胞病毒感染,均无临床症状,并全部治愈.结论:更昔洛韦能够有效治疗肝移植术后巨细胞病毒感染.积极预防、早期治疗肝移植术后患者巨细胞病毒感染是治疗成功的关键.     

Immunoglobulin levels and specific viral antibodies in relation to smooth-muscle antibodies in cytomegalovirus infection.

Among 17 patients with cytomegalovirus (CMV) infection smooth-muscle antibodies (SMA) of the IgM class were detected in 9 (53%) and IgG-SMA in 6 (35%), while no IgA-SMA were found. IgM-SMA were present most often and in the highest titres (10-160) in the beginning of the disease, while IgG-SMA were found both early and late during the course of infection. SMA occurred most frequently in patients with specific CMV antibodies of the IgM class and in patients with elevated serum alanine aminotransferase values, but these relationships were not significant. Elevated levels of serum IgG, IgA and IgM were found in CMV infection, and a correlation between serum IgM values and IgM-SMA titres was demonstrated (alpha less than 0.01). A similar correlation between serum IgG and IgG-SMA could not be established. These findings are in support of the assumption that IgM-SMA account for a minor part of the elevated serum IgM levels in CMV infection, but not of the hypothesis that the stimulus for antibody production is the release of antigens from liver cells.     

Autoantibodies against the endothelial receptor of protein C are associated with acute myocardial infarction in young women

BACKGROUND: Acute myocardial infarction (AMI) is rare among young women. The search for unknown risk factors is warranted. Endothelial protein C receptor (EPCR) is largely present at the endothelial surface of large arteries. No studies about association of anti-EPCR autoantibodies (anti-EPCR) with AMI are available. METHODS: Plasma IgA, IgM and IgG anti-EPCR levels were measured by enzyme-linked immunosorbent assay in 165 women younger than 45 years who survived a first AMI and 165 healthy women, matched by age and geographical origin. RESULTS: Using the 90th percentile of IgA anti-EPCR in the control group, IgA anti-EPCR were independently associated with AMI after adjustment for cardiovascular risk factors (OR 5.1; 95% CI 1.7-15.6; P = 0.004). The risk apparently conferred by IgA anti-EPCR increased dose-dependently (P for trend =0.0002). IgM anti-EPCR were less consistently associated with AMI: a significant increase in the risk was found when women above the 90th percentile were compared with those in the lowest quartile (OR 3.6; 95% CI 1.2-11.5; P = 0.03). IgG anti-EPCR were similar in patients and controls. A total of 145 patients underwent coronary arteriography. IgA or IgM anti-EPCR were not different among patients with different degrees of atherosclerotic lesion (anova, P = 0.77 and 0.24, respectively). CONCLUSIONS: High levels of IgA and, to a lesser extent, IgM anti-EPCR, are associated with AMI in young women.     

Comparison of two Cobas Core enzyme immunoassays with other test systems for the detection of cytomegalovirus-specific IgG and IgM antibodies

The new Cobas Core CMV IGM and IgG enzyme immunoassays (Roche Diagnostic Systems, Basle, Switzerland) were evaluated for their ability to detect cytomegalovirus (CMV)-specific IgM and IgG antibodies. Therefore, both were compared with some other commercially available and already established serological tests used in the laboratory diagnosis of CMV infection. These included the Abbott IMx CMV IgM and IgG assays, the Abbott CMV-M EIA, the Gull CMV IgM and IgG immunofluorescence tests, the medac CMV-IgM-ELA, and the Enzygnost anti-cytomegalovirus assay (Behringwerke). A total of 572 serum samples of various categories were examined and the results showed high concordances between all methods, ranging from 84.5% to 94.9%. In a follow-up on renal transplant patients, the times of first detection of seroconversions were compared. Since a high overall agreement between the Cobas Core CMV IgM and IgG enzyme immunoassays and the other test systems were observed, these new assays represent useful and reliable tools for clinical CMV diagnosis. © 1994 Wiley-Liss, Inc.     

Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single-center prospective study in high-risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME)

BACKGROUND: Measures to prevent transfusion‐transmitted cytomegalovirus (TT‐CMV) infection after hematopoietic stem cell transplantation (HSCT) include transfusion of CMV antibody–negative blood units and/or transfusion of leukoreduced cellular blood products. We assessed the incidence of TT‐CMV in CMV‐seronegative patients receiving CMV‐seronegative HSC transplants, who were transfused with leukoreduced cellular blood products not tested for anti‐CMV. STUDY DESIGN AND METHODS: In a prospective observational study between 1999 and 2009, all HSCT patients received leukoreduced cellular blood products not tested for anti‐CMV. Patients were screened for CMV serostatus and CMV‐negative recipients of CMV‐negative transplants were systematically monitored for TT‐CMV clinically and by CMV nucleic acid testing. Anti‐CMV antibodies (immunoglobulin [Ig]G and IgM) were assessed after three time intervals (Interval 1, study inclusion to Day +30 after HSCT; Interval 2, Day +30‐Day +100; Interval 3, after Day +100). RESULTS: Among 142 patients treated with allogeneic HSCT, 23 CMV‐negative donor‐patient pairs were identified. These 23 patients received 1847 blood products from 3180 donors. All patients remained negative for CMV DNA and none developed CMV‐associated clinical complications. This results in a risk for TT‐CMV per donor exposure of 0% (95% confidence interval, 0.0%‐0.12%). However, 17 of 23 patients seroconverted for anti‐CMV IgG, but none for anti‐CMV IgM. CMV IgG seroconverters received significantly more transfusions per week than nonconverters. CONCLUSION: The risk of TT‐CMV is low in high‐risk CMV^neg/neg HSCT patients transfused with leukoreduced blood products not tested for anti‐CMV. The cause of anti‐CMV IgG seroconversion is most likely passive antibody transmission by blood products.     

冠心病患者血清抗凝血酶原抗体的检测

目的检测冠心病(CHD)患者血清中抗凝血酶原抗体(aPT)的含量,以探求其与该病的临床相关性。方法应用间接ELISA法检测HCD患者血中的aPT(IgG及IgM型)及总抗磷脂抗体(aPL)(IgG及IgM型),同时计算其阳性率和优势比(OR,95%置信区间)。结果49例CHD病人IgG,IgM,IgG/IgM-aPL的阳性率分别为22.4%,14.3%和28.6%,而对照组分别为5%,5%和10%,说明aPL在CHD病人中有明显的升高(除了IgM外,P<0.05)。CHD病人的IgG,IgM,IgG/IgM-aPT的阳性率分别为12.2%,10.2%和18.4%,对照组为2.5%,2.5%和5%,虽aPT有高于对照组的趋势,但无统计学意义(均P>0.05)。尽管如此,在AMI病人中aPL和aPT均比OMI和AP病人高,aPT更为明显。结论aPT可能是AMI的危险因素之一。aPL和aPT在一些CHD病人血清中有较高的水平,检测这些患者血中的aPL及aPT,将有助于进一步完善抗磷脂抗体综合征(APS)的临床研究及这些疾病的预防、诊断及治疗。     

急性心肌梗死溶栓治疗对血浆C—反应蛋白（CRP）水平的影响

目的：研究溶栓治疗对急性心肌梗死（AMI）患者血浆C－反应蛋白（CRP）水平的影响,方法：42例确诊的AMI患者,经静脉溶栓或一般治疗,测定入院时即刻和胸痛发作后2,4,6,10,14,24小时及第2至第9天的血浆CRP,CK－MB浓度。结果：（1）AMI患者血浆CRP与CK－MB水平呈正相关,（2）溶栓治疗成功者血浆CRP峰值水平明显下降（P＜0．05）。结论：溶栓治疗可明显降低AMI患者血浆CRP水平,这种降低可能与溶栓治疗减轻了急性炎症反应有关。     

急性心肌梗死合并多器官功能障碍综合征患者血清免疫球蛋白、补体和C-反应蛋白的变化

目的:探讨急性心肌梗死(AMI)合并多器官功能障碍综合征(MODS)患者免疫功能的变化及临床意义。方法:81例AMI患者分为AMI(A)组及AMI合并MODS(B)组,分别在病后第1、7及14 d测定免疫球蛋白IgG、IgA、IgM,补体C3、C4及C-反应蛋白(CRP),并与正常对照组进行对比分析。再根据溶栓情况将81例AMI患者分为常规治疗组、溶栓未通组、溶栓再通组,溶栓后2 h再测定上述指标。结果:两组免疫球蛋白、补体均在病后第1 d明显降低,而CRP明显升高(P<0.05)。A组在病后第7 d免疫球蛋白、补体及CRP均基本恢复正常(P>0.05);而B组在病后第7 d IgG、IgA仍明显低于正常,而CRP更为升高(P<0.01),A组在病后第14 d免疫球蛋白及补体均明显高于正常(P<0.01),而B组免疫球蛋白稍高于正常;CRP下降至接近正常。溶栓再通组免疫球蛋白、补体均明显高于溶栓未通组和常规治疗组:溶栓再通组CRP明显低于溶栓未通组和常规治疗组。结论:AMI后早期免疫功能处于抑制状态,动态观察免疫球蛋白、补体及CRP在血清中的变化可作为AMI患者病情观察的客观指标。     

Lack of value of specific IgA detection in the postnatal diagnosis of congenital toxoplasmosis

To improve the performance of the postnatal diagnosis of congenital toxoplasmosis, we assessed the detection of IgA antibodies to Toxoplasma gondii by ELISA, compared with that of IgM by ELISA, ISAGA, and IFAT and neosynthesized antibodies using Western blot. From 1993 to 1996, IgA antibodies were detected using the Toxo IgA test (SFRI, Société Fran?aise de Recherches et d'Investissements, Bordeaux, France), in 195 serum and cord blood samples from 63 infants born to mothers who seroconverted during pregnancy. Eighteen infants had proven congenital toxoplasmosis (confirmed by the presence of IgG after 12 months of life) and 45 had no congenital toxoplasmosis (negativity of IgG after 6-12 months of life). The sensitivity of IgA detection by ELISA on serum and cord blood samples was 38.9 and 54.5% respectively, which is low when compared with the sensitivity of IgM detection by ISAGA (66.7% on serum samples, 90.9% on cord blood), ELISA (61.1% on sera, 81.8% on cord blood) and Western blot (83.3% on sera, 72.7% on cord blood). IgA antibodies were never detected by ELISA earlier than IgM or neosynthesized Ig (antibodies synthesized by infants). Thus, the detection of IgA antibodies by Toxo IgA is not useful in improving the diagnosis of congenital toxoplasmosis.     

A new immunoassay of human antibodies to chemical carcinogens

The study was undertaken to optimize the well known immunoassay of antibodies to chemical carcinogens, designed by J. Chagnaud et al., and examine the specific features of the generation of antibodies (Ab) to benzo[a]pyrene (BP) in patients with lung cancer. Ninety-two serum samples from healthy males and 80 samples from patients with lung cancer were studied. Increased efficiency was achieved by the use of bovine serum albumin instead of thyreoglobulin in the synthesis of carrier protein conjugates with BP. Better reproducibility was accomplished, by using the control serum sample with the known content of IgM, IgG, and IgA Ab to BP. Analysis of the study serum samples has established that in healthy male smokers, the count of IgA Ab was twice greater than that in non-smokers. The patients with lung cancer were found to higher levels of IgG and IgA Ab to BP (in both smokers and non-smokers) than healthy individuals. It is proposed to use the stated method to study a role of A to chemical carcinogens in the pathogenesis of malignancies.