血清免疫球蛋白诊断乙型肝炎相关肝硬化的价值

目的评价血清免疫球蛋白G（1gG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）诊断肝硬化的价值。方法慢性乙型肝炎172例，其中病理诊断为肝硬化的患者28例，非肝硬化患者144例。统计分析采用SPSS12．0软件；血清IgG、IgA和IgM水平诊断肝硬化的评价采片jROC曲线法。结果血清IgG、IgA和IgM水平诊断肝硬化的ROC曲线下面积分别为0．764（95％CI=0．670～0．857）、0．670（95％CI=0．566～0．773）和0．557（95％CI=0．449～0．664）。血清IgG和IgA水平诊断肝硬化的最佳截断值分别为16．85g／L和1．89g／L，其诊断肝硬化的灵敏度、特异度、阳性预测值、阴性预测值、准确度、Youden指数分别为0．821和1．000、0．660和0．285、0．319和0．214、0．950和1．000、0．686和0．401、0．481和0．285。结论血清IgG水平可作为否定诊断肝硬化的参考指标；虽然血清IgA水平也有一定否定诊断肝硬化的价值，但其可靠性很差；血清IgM水平没有诊断肝硬化的意义。     

替诺福韦酯经治慢性乙型肝炎和乙型肝炎肝硬化患者血清免疫球蛋白和补体水平的变化

目的观察替诺福韦酯抗病毒经治乙型肝炎和乙型肝炎肝硬化患者血清免疫球蛋白IgG、IgA、IgM和补体C3、C4的变化,探讨替诺福韦酯治疗对于患者体液免疫功能的影响。方法选取2017年1月至2017年9月于兰州军区总医院安宁分院就诊的慢性乙型肝炎患者(31例)和乙型肝炎肝硬化患者(19例)为研究对象,所有患者均给予替诺福韦酯(300 mg口服,1次/d)抗病毒治疗。于治疗前、治疗3个月和治疗6个月采集血液标本,采用免疫透视比浊法检测血清免疫球蛋白IgG、IgA、IgM和补体C3、C4水平,并进行统计分析。结果慢性乙型肝炎组患者血清IgG、IgA、IgM和C4水平在治疗3个月和6个月与治疗前相比,差异均有统计学意义(P均0.05),C3水平差异无统计学意义(P 0.05);治疗6个月时血清IgG、IgA和IgM水平显著低于治疗3个月(P均0.05),血清C3和C4水平差异无统计学意义(P均 0.05)。肝硬化组患者血清IgG、IgA、IgM和C4水平在治疗3个月时与治疗前相比,差异均有统计学意义(P均0.05),C3水平差异无统计学意义(P 0.05);治疗后6个月与治疗前相比,IgG、IgA、IgM、C3和C4水平差异有统计学意义(P均0.05);治疗6个月和3个月相比血清IgG显著下降(P均0.05),血清IgA、IgM、C3和C4水平差异无统计学意义(P均 0.05)。Child Pugh B级肝硬化患者较Child Pugh A级患者各指标变化更显著,差异有统计学意义(P 0.05)。结论经替诺福韦酯抗病毒治疗后,慢性乙型肝炎患者和乙型肝炎肝硬化患者血清免疫球蛋白IgG、IgA、IgM和补体C3、C4水平均有不同程度的恢复。     

抗病毒治疗对慢性乙型肝炎患者免疫球蛋白及补体的影响

目的 探讨慢性乙型肝炎(慢乙肝)患者使用核苷类抗病毒药物前后对免疫球蛋白及补体的影响.方法 选取慢乙肝患者共157例,50例接受抗病毒治疗,分别在其使用核苷类抗病毒药物前,抗病毒治疗后的第1、2、3、4周,用ELISA法检测HBV血清学标志物,RT-PCR法检测HBV DNA,免疫比浊法测定IgG、IgA、IgM和C3、C4、总补体(CH50)、C反应蛋白(CRP).均数比较采用t检验和Mann-Whitney检验.相关分析采用Pearson相关系数检验.结果 慢性乙型重型肝炎及肝硬化组患者的IgA、IgM明显高于慢乙肝组(P＜0.01).三组间C3、C4、CH50、CRP水平比较,差异有统计学意义.HBeAg阳性与HBeAg阴性患者的C3、IgM、IgG及HBV DNA水平比较,差异有统计学意义.HBeAg阳性者中,高HBV DNA水平的患者与低水平HBV DNA患者相比,其IgA、IgM、C3和CH50水平均差异有统计学意义.HBeAg阴性患者中,高HBV DNA水平的患者与低水平HBV DNA患者相比,IgA水平差异有统计学意义.经抗病毒治疗,三组患者的免疫球蛋白及HBV DNA较治疗前下降,补体系统较前回升,在第4周时差异有统计学意义.HBV DNA的水平与C3呈负相关(r=-0.78,P=0.021).HBeAg定量与C3呈正相关(r=0.87,P=0.015).结论 血清免疫球蛋白、CRP、C3、C4和CH50可以反映肝脏炎性活动状态;C3的变化可以预测抗病毒治疗的效果.     

肝活组织检查确诊乙型肝炎肝硬化的临床高危因素分析

目的分析由肝活组织检查确诊乙型肝炎肝硬化的临床高危因素。方法采用1∶2配比的病例对照研究设计。收集2009年4月-2012年10月住院并行肝活组织检查的慢性乙型肝炎(CHB)患者的临床资料,将其中乙型肝炎肝硬化患者79例设为病例组(肝硬化组);同期住院的CHB非肝硬化患者158例设为对照组(非肝硬化组)。对2组的临床相关因素进行单因素分析及Logistic多因素回归分析。单因素分析中,计数资料比较采用卡方检验,计量资料采用t检验。然后选择有统计学意义的指标进行Logistic多因素回归分析。结果单因素分析显示肝硬化组的男性例数、HBeAg阴性例数、年龄、AST、GGT、IgG、透明质酸(HA)水平明显高于非肝硬化组,而Alb、PLT、HBV DNA、层粘连蛋白(LN)水平肝硬化组明显低于非肝硬化组,2组差异均有统计学意义(P均0.05)。以是否肝硬化为因变量,以其他因素为自变量,进行非条件的Logistic多因素回归分析,结果显示年龄增大(β=0.046,OR=0.955)、GGT升高(β=0.040,OR=0.960)、IgG升高(β=0.179,OR=0.836)是发生肝硬化的高危因素,而Alb升高(β=-0.114,OR=1.120)、PLT升高(β=-0.024,OR=1.024)是肝硬化的保护因素。结论年龄增大、Alb减低、GGT升高、PLT减低、IgG升高是ALT波动在0~80 U/L之间的CHB患者发生肝硬化的高危因素,临床中对于此类患者应注意监测上述指标,特别是对PLT、IgG、GGT指标的检测,有针对性地进行肝活组织病理检查,避免漏诊、误诊。     

HIE患儿外周血淋巴细胞免疫分型、免疫球蛋白水平变化及意义

目的 观察新生儿缺氧缺血性脑病（HIE）患儿外周血淋巴细胞免疫分型及血清免疫球蛋白水平变化,并探讨其临床意义.方法 选取60例HIE患儿为HIE组,其中轻度32例,中重度28例.另选同期健康足月新生儿30例作为对照组.采用流式细胞术测定两组患儿外周血淋巴细胞免疫分型,采用免疫比浊法测定血清免疫球蛋白IgG、IgM、IgA水平.结果 HIE组患儿外周血IgM、IgA水平低于对照组（P均＜0.01）,且中重度患儿外周血IgM、IgA水平均低于轻度组及对照组（P均＜0.05）.结论 HIE患儿外周血IgM、IgA水平降低.血清免疫球蛋白可以作为HIE早期诊断、评价脑损伤程度及预后的参考指标.     

手足口病患儿血清免疫球蛋白表达水平与疾病进展相关性分析

目的探讨轻症和重症手足口病(hand,foot and mouth disease,HFMD)患儿血清免疫球蛋白变化与疾病进展的相关性。方法选择本院2013年6月住院的轻症和重症HFMD患儿369例,其中轻症组259例,重症组(含危重型)110例;以同期30名体检正常的健康儿童为对照组。采用免疫比浊法检测各组血清免疫球蛋白(IgA、IgG、IgM)和补体C3、C4表达水平。比较各组及重症组肠道病毒71型(enterovirus 71,EV71)感染和非EV71感染患儿、柯萨奇病毒A16(coxsackievirus A16,CoxA16)感染和EV71感染患儿的血清免疫球蛋白表达水平。结果与对照组相比,重症组IgG、IgA和IgM水平显著升高,轻症组IgM水平显著升高;与轻症组相比,重症组IgG和IgA水平显著升高;重症组EV71感染患儿IgM水平显著高于非EV71感染患儿,其IgG和IgM水平显著高于CoxA16感染患儿;各组间补体C3、C4水平比较差异均无统计学意义。结论 HFMD患儿血清免疫球蛋白表达水平存在变化,随着病情进展,血清免疫球蛋白表达水平变化更加显著。重症患儿血清免疫球蛋白表达水平显著高于轻症患儿,重症患儿中EV71感染者较CoxA16感染者血清免疫球蛋白表达水平变化更加显著。     

急性白血病患者侵袭性真菌感染后的免疫功能改变

目的 探讨急性白血病(AL)患者的免疫功能与侵袭性真菌感染(IFI)的关系.方法 采用流式细胞术对61例发生IFI的AL患者AL初诊和缓解时、IFI发病时和抗真菌治疗4周后T淋巴细胞亚群、NK细胞进行检测,用免疫比浊法测定免疫球蛋白IgG、IgM、IgA含量.统计学方法采用方差分析、t检验和卡方检验.结果 AL患者IFI发病时,CD3+、CD3+CD4+、CD8+CD28+T淋巴细胞、CD4+/CD8+细胞比例均低于AL初诊和缓解以及抗真菌治疗4周后(F=25.6,26.6,13.1,167.9;均P＜0.05),CD8+CD28 T淋巴细胞显著高于AL初诊和缓解以及抗真菌治疗4周后(F=220.2,P＜0.01).抗真菌治疗4周有效者CD3+、CD3+CD4+、CD4+/CD8+均高于无效者(t=3.75,8.61,3.17;均P＜0.05).AL患者血清中IgG、IgM、IgA含量在IFI发病时、AL初诊和缓解以及抗真菌治疗4周后差异无统计学意义(F=0.78,0.72,0.81;均P＞0.05).AL缓解者IFI治疗有效率明显高于未缓解者(87%比53%,x2=7.62,P＜0.05).结论 IFI发生时,AL患者细胞免疫功能受损明显,而IgG、IgM、IgA含量变化不明显.抗真菌感染疗效在一定程度上取决于机体细胞免疫功能的恢复和AL缓解.     

支原体肺炎患儿血清体液免疫检测的临床研究

目的探讨支原体肺炎(MP)患儿体液免疫IgG、IgM、IgA在其发病机制中的作用。方法分析我院收治的36例支原体肺炎患儿作为病例组,同期42例健康患儿作为对照组。检测两组小儿血清免疫球蛋白IgG、IgM、IgA含量,并进行比较。结果支原体肺炎患儿血清IgG、IgM显著高于对照组,P<0.0001,P<0.0001;血清IgA水平两组比较差别无统计学意义,P=0.74。结论支原体肺炎病儿体液免疫IgG、IgM应答增强,在其发病机制中起重要作用。     

老年脂肪肝患者血清免疫球蛋白和肝纤维化指标水平的临床评价

目的 探讨老年脂肪肝病人血清免疫球蛋白（Ig）水平与肝纤维化的关系。方法 采用免疫散射比浊法检测108例老年脂肪肝患者血清IgA、IgG、IgM含量及采用放射免疫吸附试验（RIA）测定血清透明质酸（HA）、Ⅳ型前胶原肽（IVC）及层黏连蛋白（LN）水平，并分析其相关性。结果 老年脂肪肝患者血清IgA、IgG、IgM含量明显高于对照组（P〈0．01），肝纤维化指标HA、IVC、LN水平明显高于对照组（P〈0．01），而且患者血清IgA、IgG、IgM与HA、IVC、LN之间呈显著正相关（P〈0．01或P〈0．05）。结论 老年脂肪肝有较为明显的肝纤维化倾向。检测其血清IgA、IgG、IgM与HA、IVC、LN含量，对于脂肪肝纤维化的诊断及评估预后具有重要的临床意义。     

HBV-ECPGN患者IgG、IgA、IgM、C3d的水平变化及其临床意义

目的探讨毛细血管内增生性肾小球肾炎伴乙型肝炎病毒抗原沉积(HBV-ECPGN)患者的IgG、IgA、IgM、C3d变化及其临床意义。方法选取2015年5月至2017年2月在我院接受治疗的HBV-ECPGN患者为研究对象,选取同期在我院接受治疗的单纯肾小球肾炎患者为对照组。观察两组患者血清IgG、IgA、IgM、C3d水平的差异,比较两组患者肾功能、肝功能指标、细胞因子水平的差异,分析HBV-ECPGN患者IgG、IgA、IgM、C3d与肾功能、肝功能指标、细胞因子水平的相关性。结果观察组患者的IgG、IgA、IgM和C3d水平均高于对照组(t=-52.499、-65.068、-12.995、-35.122,P0.001);观察组患者的尿素氮(BUN)、血肌酐(sCr)水平高于对照组(t=-8.680、-4.062,P0.001),肾小球滤过率(GFR)水平低于对照组(t=3.120,P=0.001);观察组患者的ALT、AST和TBil水平高于对照组(t=-14.848、-18.508、-12.209,P0.001);观察组患者的IL-10、IL-6和IL-12水平高于对照组(t=-16.357、-16.782、-24.748,P0.001);HBV-ECPGN患者IgG、IgA、IgM、C3d水平与BUN、sCr、ALT、AST、TBil、IL-10、IL-6和IL-12水平正相关,与GFR水平负相关。结论 HBV-ECPGN患者的IgG、IgA、IgM、C3d水平较高,且与肝肾功能和细胞因子水平密切相关。     

Value of serum immunoglobulins in the diagnosis of liver disease

Serum immunoglobulins were determined in 145 consecutive patients with biopsy-proven steatosis, alcoholic hepatitis, alcoholic hepatitis with fibrosis, alcoholic hepatitis with cirrhosis, inactive cirrhosis, chronic active alcoholic hepatitis, chronic active hepatitis, primary biliary cirrhosis and nonspecific hepatitis. IgM was both a sensitive (90.5%) and specific (86.2%) marker for primary biliary cirrhosis, and mean IgM levels were higher in primary biliary cirrhosis than in other diagnostic categories (p less than 0.05). IgA levels were most commonly elevated in alcoholic liver disease (p less than 0.005). IgA detected 95% of alcoholic disease, but was poorly specific (41.1%). A trend of rising IgA with increasing severity of alcoholic injury was observed, but the differences were not significant. IgG was most commonly elevated in chronic active hepatitis and alcoholic hepatitis with cirrhosis, but the IgG values did not differ significantly from those found in other diagnostic categories. Our results substantiate assertions of a diagnostic sensitivity for elevated IgA in alcoholic liver disease and IgM in primary biliary cirrhosis. With the exception of IgM in primary biliary cirrhosis, however, serum immunoglobulins are not specific markers of liver histology.     

Evaluation of complement component C4 concentration and immunoglobulins IgA, IgG, and IgM in serum of patients with primary essential hypertension

The aim of the study was to determine serum concentration of complement component C4 and IgA, IgG, IgM immunoglobulins in hypertensive patients and healthy controls as well as to assess the interrelationships regarding some immunological and clinical data in the study group. The study group consisted of 81 hypertensive patients (with secondary forms of hypertension excluded), 44 females and 37 males (mean age 51.2 +/- 14.5 years). The control group comprised 34 healthy volunteers, 19 females and 15 males (mean age 47.5 +/- 15.3 years). C4, IgA, IgG, IgM serum concentrations were evaluated with turbidymetry. C4 serum concentration was significantly higher in hypertensive patients when compared to the controls. No significant differences in IgA, IgG, IgM serum concentrations existed between the groups. The duration of hypertension correlated positively with C4 serum concentration. Elevated C4 serum concentration may be one of the markers of immunological disturbances existing in hypertensive patients. IgA, IgG, IgM immunoglobulins do not seem to be directly associated with essential hypertension.     

Salivary immunoglobulins and antibody activities in leprosy

The technics of immunodiffusion and the fluorescent leprosy antibody absorption (FLA-ABS) test were used to determine the levels of immunoglobulins and their antibody activities against Mycobacterium leprae in the serum and the saliva collected from a total of 110 patients with leprosy (50 lepromatous, 24 borderline, and 36 tuberculoid). The average levels of serum IgG, IgM, and IgA were not significantly different among these patients. In saliva, however, IgM was detected in only two cases with lepromatous leprosy and three tuberculoid cases. Salivary IgG and IgA levels and their ratios to those in the sera were not significantly different according to the classification of leprosy. The percentages of positive FLA-ABS tests in the sera and saliva were compared by using fluorescent antibodies specific for IgG, IgM, and IgA, respectively. The results indicated that M. leprae-specific antibodies in the serum were mainly found in IgG and IgM and, less frequently, in IgA. IgG antibodies were found more frequently in lepromatous and borderline patients than in tuberculoid cases. On the other hand, salivary IgA antibodies against M. leprae were found in a significant number of specimens; whereas IgG and IgM antibodies were scarcely found. However, the percentage of positive FLA-ABS tests caused by salivary IgA antibodies was higher in the patients with tuberculoid or borderline leprosy than in those with lepromatous leprosy. A significant number of patients with tuberculoid or borderline leprosy secreted M. leprae-specific IgA antibodies into saliva without detection of circulating IgA antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Immunoglobulin production by coeliac biopsies in organ culture.

The production of immunoglobulins by jejunal mucosa during organ culture has been studied. In 18 untreated coeliac patients the amounts of IgA, secretory IgA and IgM in the culture medium were higher than in those from 17 normal controls. The results in 15 treated coeliac patients did not differ from the control subjects. Mucosal biopsies from patients with serum IgA deficiency produced very little IgA, but large amounts of IgG and IgM. The addition of neither Frazer's gluten fraction III, nor alpha-gliadin to the culture system stimulated any additional increased secretion of immunoglobulins from the untreated coeliac patients. Production of IgA and IgM by the small bowel mucosa continues during organ culture, but that of IgG appears insignificant.     

Diagnostic value of the concentration of M-component in initial classification of monoclonal gammopathy

The diagnostic value of the concentration of a serum M-component in initial classification of monoclonal gammopathy into malignant monoclonal gammopathy (MMG) and monoclonal gammopathy of undetermined significance (MGUS) was evaluated in 315 consecutive individuals with IgG, IgA or IgM type M-components. The final diagnosis was MMG in 84 and MGUS in 231 patients. Serum concentration was significantly highest in MMG, but for all 3 kinds of M-components, overlapping serum concentrations between MMG and MGUS were found. Highest efficiency was reached with a serum concentration of 30.2 g/l for IgG, 26.6 g/l for IgA and 22.7 g/l for IgM. Using these values, an initial correct classification was achieved in 0.90 of IgG M-components, in 0.91 of IgA M-components and in 0.79 of IgM M-components. Normal levels of uninvolved immunoglobulins were found to point strongly to MGUS.     

Hepatic function and significance of the increase in serum concentrations of IgA in alcoholic cirrhosis

Elevated serum gammaglobulin concentrations are frequently observed in patients with liver cirrhosis. Predominant elevation of the IgA is generally considered as suggestive of an alcoholic aetiology. The aim of this study was to define the factors that determine the serum concentration of IgA in alcoholic cirrhosis. Twenty-seven patients with alcoholic cirrhosis were studied. Serum concentrations of IgG, IgA and IgM were measured by immunonephelometry. Hepatocellular function was assessed by the Child-Turcotte score, the prothrombin time and the intrinsic clearance of indocyanine green. The importance of intra-hepatic shunts was estimated according to the intact hepatocyte theory, and the degree of hepatic necrosis by serum levels of transaminases. It was noted that: 1) the IgA concentration correlated significantly with the Child-Turcotte score and with the decrease of the prothrombin time, intrinsic clearance and the functional fraction of hepatic blood flow; 2) there was no such correlation between the serum concentration of IgA and the total hepatic blood flow or transaminase levels; 3) there was no correlation between serum concentration of IgG or IgM and the factors studied. These results suggest that in alcoholic cirrhosis, increase in serum IgA, reflects the degree of impairment of hepatic function and intrahepatic shunting.     

Immunoglobulins on the surface of monosodium urate crystals: an immunoelectron microscopic study

The ability of monosodium urate (MSU) crystals to bind immunoglobulins from human serum was investigated by immunoelectron microscopy. Synthetic MSU crystals were incubated with serum and then processed with an indirect immunoperoxidase technique which used primary antibodies directed against human IgG, IgA or IgM, respectively specific for Fc fragments, alpha chains, and mu chains. Results were analyzed by transmission electron microscopy on intact crystals dried on formvar coated grids, and in thin sections. Both techniques demonstrated the binding of IgG, IgA and IgM to MSU crystals and the availability of the Fc fragment of the crystal bound IgG for immunologic reactions.     

Individual serum proteins and acute phase reactants in monoclonal immunoglobulinopathies (a study in patients with IgG myeloma)

In 92 patients with multiple myeloma and IgG monoclonal proteinemia concentrations of seventeen different serum proteins were specifically determined. Prealbumin, albumin, alpha, HS-glycoprotein, alpha-macroglobulin, transferrin and immunoglobulins IgA, IgM and IgD were significantly decreased in patients with IgG myeloma. On the contrary the means found for the typical acute phase proteins i.e. haptoglobin, orosomucoid and CRP were significantly elevated. No significant differences were demonstrated for less typical acute phase protients, i.e. alpha1-antitrypsin, ceruloplasmin and C3-component as well as for hemopexin and beta2-glycoprotein I. CRP values were strongly elevated in some sera, however in majority of patients they were within the normal limits. Negative correlation was found between monoclonal IgG and the most of the studied proteins inclusive immunoglobulins IgA, IgM and IgD. No correlation was demonstrated between the monoclonal IgG and the triad of typical acute phase proteins. Positive correlation was found between monoclonal IgG and the total serum protein and further among the proteins negatively correlated with monoclonal IgG as well as among the individual acute phase proteins. Explanation of the correlations reported has been suggested.     

慢性阻塞性肺疾病长期机械通气患者T细胞亚群、补体及免疫球蛋白的变化

目的研究慢性阻塞性肺疾病(COPD)长期机械通气患者T细胞亚群、补体及免疫球蛋白的变化规律.方法选择2003年3月至2005年2月解放军总医院老年病房收治的COPD长期机械通气患者42例,同时选择COPD稳定期的老年患者34例作为对照组.入选患者均进行免疫球蛋白IgA、IgG、IgM,补体C3、C4,及CD4、CD8的测定,并计算出CD4/CD8比值.结果COPD长期机械通气组与对照组比较,IgA、IgG、IgM均增高,补体C3、C4均降低,CD4降低、CD8升高,CD4/CD8降低.经统计学处理,除补体C3无统计学差异(P＞0.05)外,其余各项指标均有显著差异(P＜0.05).结论COPD长期机械通气患者T细胞亚群、补体及免疫球蛋白均存在异常,呼吸机相关肺炎的发生可能与免疫功能异常有关.