小剂量利妥昔单抗治疗难治性血小板减少性紫癜的临床研究

目的研究小剂量利妥昔单抗治疗难治性血小板减少性紫癜的临床疗效。方法选自我院2008年1月～2010年12月收治的难治性血小板减少性紫癜患者34例,均分为小剂量组及常规剂量组,其中小剂量组选择使用利妥昔单抗100mg／m^2,连续使用4周,常规剂量组使用剂量为375mg／m^2,患者治疗前后每周均检测血常规2次,测定血清免疫球蛋白量及血小板数量等进行疗效评估,并进行统计学分析。结果小剂量组与常规剂量组治疗后血小板数与治疗前比较,差异均有统计学意义;小剂量组治疗后与大剂量组治疗后效果对比,差异有统计学意义（P〈0．05）。小剂量组患者有效率为94．12％,大剂量组患者有效率为58．82％,两组有效率比较差异有统计学意义（P〈0．05）。结论小剂量的利妥昔单抗治疗难治性血小板减少性紫癜效果明显,并发症少,值得临床进一步推广。     

强直性脊柱炎患者外周血中B淋巴细胞亚群、B细胞活化因子及其受体的表达研究

目的 研究强直性脊柱炎(AS)患者外周血中B淋巴细胞亚群、B细胞活化因子(BAFF)及其受体BP3的表达,为进一步探讨AS发病机制提供新的理论依据.方法 采用流式细胞术测定24例AS患者及30名正常健康体检者外周血中CD19+总B细胞、CD19+ CD20+ CD27 -初始B细胞、CD19+ CD20+ CD27+记...     

丹镁合剂对兔腰椎间盘突出症模型动物血清IgG、IgM的影响

目的：探讨丹镁合剂对自身免疫引起的炎症反应的影响。方法：60只日本大耳白兔按照随机数字表法分为空白组（10只）,假手术组（10只）,造模组（40只）。对造模组大耳白兔制造腰椎间盘突出模型,待造模成功后,造模组40只兔子再随机分成4组：模型组（A组,10只）,生理盐水组（B组,10只）,七叶皂甙钠组（C组,10只）,丹镁合剂组（D组,10只）。生理盐水组兔耳静脉给予生理盐水（5ml/kg）;七叶皂甙钠组耳缘静脉给予七叶皂甙钠（0.5mg/kg）;丹镁合剂组耳缘静脉给予丹镁合剂（2.0ml/kg）;共连续给药14d。空白组、假手术组及模型组未予给药。应用ELISA法观察不同药物对免疫反应和炎症反应的影响。结果：模型组IgG、IgM明显高于空白组与假手术组（P〈0.05）;丹镁合剂组血清中IgG、IgM含量明显降低,与七叶皂甙钠组和生理盐水组比较有明显的统计学意义（P〈0.05）。结论：丹镁合剂可以明显抑制腰椎间盘突出症自身免疫反应,这为临床治疗椎间盘突出症提供了一种新的治疗选择。     

肾移植术后急性体液性排斥反应的治疗

目的 总结肾移植术后急性体液性排斥反应中针对HLA抗体的检测和处理经验.方法 肾移植受者15例,术前行HLA分型、交叉配型和群体反应性抗体(PRA)的检测,术后采用他克莫司(或环孢素A)、霉酚酸酯和糖皮质激素预防排斥反应.15例于肾移植后1～14 d发生抗体介导的急性排斥反应(AMR),采用抗胸腺细胞球蛋白(100 mg/d,使用5 d)治疗,或将环孢素A转换为他克莫司,当PRA明显升高,且血清中出现供者特异性HLA抗体时,即行血浆置换(PP),共行1～5次,每次PP后静脉输注免疫球蛋白(IVIG)100～150 mg/kg,最后1次PP后给予WIG 200～500mg/kg.结果 术后出现抗供者特异性HLA Ⅰ类抗体者9例,抗HLAⅡ类抗体者4例,同时出现抗Ⅰ、Ⅱ类抗体者2例.14例的AMR逆转,1例术后发生移植肾功能恢复延迟,彩色多普勒超声波显示移植肾血流灌注差,于术后第10天切除移植肾.并行二行肾移植.2例AMR后并发急性肾小管坏死,透析后移植肾功能恢复正常.抗排斥反应治疗期间患者均未发生严重感染.随访12～52个月,1例因慢性移植肾肾病恢复血液透析治疗,1例死于心血管疾病,其余患者移植肾功能稳定.结论 将ATG、PP和IVIG联合应用能有效逆转AMR.     

Food fight! Parenteral nutrition,enteral stimulation and gut-derived mucosal immunity

Introduction  Nutrition support is an integral component of modern patient care. Type and route of nutritional support impacts clinical infectious outcomes in critically injured patients. Discussion  This article reviews the relationships between type and route of nutrition and gut-derived mucosal immunity in both the clinical and laboratory settings.     

过敏性紫癜性肾炎患儿血清总IgE和嗜酸细胞阳离子蛋白的检测及临床意义

目的探讨血清总IgE和嗜酸细胞阳离子蛋白（ECP）水平在儿童过敏性紫癜性肾炎（HSPN）中的临床意义。方法用免疫荧光酶标法测定46例不同病程HSPN患儿血清总IgE和ECP的水平。结果HSPN发作组患儿血清总IgE（126．1±63．7）kU／L和ECP（16．3±6．5）μg／L明显高于缓解组的（14．7±8．5）kU／L、（3．9±1．4）μg／L以及对照组的（17．7±6．3）kU／L、（3．1±1．7）μg／L。首次发作患儿血清ECP（23．0±8．7）μg／L高于治疗后复发患儿（9．3±2．2）μg／L,以上差异均有显著性。首次发作组的IgE（142．5±58．5）kU／L与治疗后复发组（93．5±32．3）kU／L之间无统计学差异。缓解组的IgE和ECP与对照组相比均无统计学差异。结论血清ECP和IgE水平反映了HSPN的活动情况,可以作为监测病情和疗效的指标之一。     

儿童急、慢性荨麻疹IgE及嗜酸性粒细胞检测分析

目的探讨儿童急、慢性荨麻疹Ig E水平和嗜酸性粒细胞变化及其临床意义。方法分别用化学发光法、酶免荧光法和VCS(体积、电导性和散射)原理检测77例急性和46例慢性荨麻疹患儿血清总Ig E水平,食物、螨虫及植物类特异性Ig E和嗜酸性粒细胞比例,比较急、慢性荨麻疹患儿间上述指标的差异。结果伴有其它过敏性疾病的急、慢性荨麻疹患儿间血清总Ig E水平,食物、螨虫及植物类特异性Ig E阳性率差异无统计学意义(P0.05),但不伴有其它过敏性疾病的慢性荨麻疹患儿总Ig E水平显著高于急性荨麻疹患儿(P0.05);男性血清Ig E水平显著高于女性;随着年龄增长,总Ig E水平呈一定的增长趋势;螨虫类Ig E阳性率显著高于食物及植物类(P0.05)。急、慢性荨麻疹患儿嗜酸性粒细胞升高率差异无统计学意义(P0.05)。结论嗜酸性粒细胞比例不能作为儿童急、慢性荨麻疹鉴别诊断的指标。Ig E在无其它过敏性疾病的儿童急、慢性荨麻疹的鉴别诊断中具有一定的价值,但在其它情况,血清总Ig E水平不能作为儿童急、慢性荨麻疹鉴别诊断的指标,必须结合患儿病史、病程及临床症状方能作出正确的诊断。     

IgG4-subclass of glutamic acid decarboxylase antibody is more frequent in latent autoimmune diabetes in adults than in type 1 diabetes

Aims/hypothesis Glutamic acid decarboxylase autoantibodies (GADA) are the most frequent beta-cell-specific autoantibodies in type 1 diabetes and in latent autoimmune diabetes in adults (LADA). The autoimmune attack on pancreatic islet cells is associated with a T helper 1 cell (T_h1) response, mainly represented by IgG₁-subclass in humans. It has been proposed that the presence of IgG₄ may be associated with a T_h2 response. The aim of our study was to compare the GADA IgG-subclass distribution between adult patients with type 1 diabetes and LADA.Methods Patients with type 1 diabetes (n=45) and patients with LADA (n=60) were included. Radioimmunoprecipitation assay with IgG-subclass specific Sepharose (IgG₁, IgG₂, IgG₃ and IgG₄) was used to precipitate the antibody/antigen-complex.Results We only detected IgG₄-subclass of GADA in subjects with LADA (26.7%; p<0.001). IgG₁ was the most common GADA-subclass in both groups, however IgG₁ as the solely expressed subclass was more common among type 1 diabetic patients (77.8%; p<0.05). The rank order of the frequencies of IgG-subclasses in type 1 diabetes was IgG₁>IgG₃>IgG₂>IgG₄ and in LADA patients IgG₁>IgG₄>IgG₂>IgG₃.Conclusions/interpretation The difference in GADA IgG-subclasses could indicate a different immune response, possibly an altered balance between T_h1 and T_h2 cytokine profile in pancreatic islets. This difference could contribute to the slower rate of beta cell destruction in LADA patients, as reflected by a higher C-peptide level at clinical onset.     

Hodgkin's disease developing after spontaneous remission of chronic lymphocytic leukemia

We present a 71-year-old patient with chronic lymphocytic leukemia diagnosed 27 years ago. Initially, the disease was staged as Rai II and the patient suffered from secondary immunoglobulin deficiency. Nevertheless, no treatment was necessary at that time. Because of disease progression a single course of chemotherapy was given in 1984. During the following year there was a constant decline of the WBC, accompanied by normalization of the immunoglobulins; both have remained stable ever since that time. However, there was still residual bone marrow infiltration, indicating persisting CLL. In 1993 cervical lymphadenopathy occurred with acute onset. A diagnostic lymphadenectomy revealed Hodgkin's disease of the nodular-sclerosing subtype. The patient was staged as II–III according to the Ann Arbor Classification and underwent radiation therapy. Cytogenetic examination of the bone marrow revealed a normal karyotype with an inversion of chromosome 9. This case demonstrates the rare coincidence of two lymphoproliferative disorders in the same patient. The clinical course and the immunologic findings of this patient are presented, together with a review of the literature.