乙肝免疫球蛋白联合乙肝疫苗阻断乙肝感染父婴传播的可行性分析

目的观察乙肝疫苗与乙肝免疫球蛋白联合应用对乙肝感染父婴传播阻断的临床效果。方法2012年1月至2015年5月在湛江中心人民医院分娩的产妇及其配偶68对为研究对象,产妇均未感染乙肝病毒,配偶均为乙肝患者,随机分为观察组和对照组各34对。对照组新生儿注射乙肝疫苗,观察组在对照组基础上加用乙肝免疫球蛋白。观察两组新生儿出生体质量、Apgar评分、丙氨酸氨基转移酶(ALT)水平及乙型肝炎病毒(HBV)检测结果。结果两组新生儿出生体质量、Apgar评分以及ALT水平比较差异无统计学意义(P0.05);观察组新生儿HBsAg阳性率为5.88%(2/34),低于对照组23.53%(8/34),差异有统计学意义(P0.05);观察组新生儿HBsAb阳性率为32.35%(11/34),高于对照组11.76%(4/34),差异有统计学意义(P0.05)。结论新生儿应用乙肝疫苗联合乙肝免疫球蛋白,能够对感染乙肝病毒的父婴传播进行有效阻断,明显降低新生儿感染率。     

B细胞激活因子与过敏性紫癜相关性研究

目的:通过分析B细胞激活因子(BAFF)与患者免疫球蛋白在不同类型过敏性紫癜(HSP)中的表达,初步探讨BAFF在过敏性紫癜免疫发病机制中的作用。方法:收集HSP活动期患者,包括皮肤型30例、关节型30例、腹型32例、肾型31例、混合型41例,将健康人40例作为对照组。速率散射比浊法测定免疫球蛋白水平;ELISA方法检测BAFF蛋白含量。结果:IgA仅在混合型HSP中增高,IgG和IgM在各组中并无增高;不同类型HSP活动期患者血清中BAFF表达水平均明显高于对照组;混合型HSP患者血清中BAFF表达水平与同型患者IgA表达水平呈中等程度的相关性。结论:BAFF与HSP发病时的体液免疫增强有关。     

类风湿因子分型检测的临床应用

目的探讨类风湿因子（RF）分型定量检测对类风湿性关节炎（RA）诊断、治疗及预后的意义。方法采用ELISA方法定量检测RA患者组和其他风湿病组患者血清中IgG-RF、IgM-RF、IgA-RF含量，同时用散射比浊法检测RA患者组患者血清中RF含量。结果散射比浊法检测RF阳性率为58．56％，ELISA分型方法检测RF阳性率为81．77％，ELISA方法分型检测RF阳性率高于散射比浊法（P〈0．01）。RA患者组与其他风湿病患者组血清中各型RF含量两两比较，RA患者组RF IgM、IgA及IgG均显著高于其他风湿病组（P〈0．05）。结论ELISA方法分型定量检测RF阳性率高，特异性强，对RA患者的诊断、活动度及疗效观察有较大临床意义。     

Immunoglobulin G levels during collection of large volume plasma for fractionation

Background

There is a need of comprehensive work dealing with the quality of plasma for fractionation with respect to the IgG content as today most plasma derivates are used to treat patients with immunodeficiencies and autoimmune disorders. Therefore, a prospective study was carried out to analyse IgG levels before plasmapheresis and every 200 ml collected plasma.

Characteristics of the complex between alkaline phosphatase and immunoglobulin A in human serum

An abnormal band of alkaline phosphatase (ALP) activity was detected by electrophoresis in the serum of a patient with liver cirrhosis, and was shown to be a complex between ALP and immunoglobulin A (IgA) of the lambda type.

Physicochemical studies of ALP in the patient's serum showed properties of liver and bone isozymes. The patient's IgA and its F(ab')₂ fragment were prepared by column chromatography, and used in in-vitro reconstitution studies with various ALP isozymes. It was found that only the liver and bone ALP attached to the IgA, while the placental and intestinal ALP did not. The ALP was attached to the F(ab')₂ fragment of IgA. It is concluded that this complex is the result of an antibody-antigen reaction. Molecular weights of the two complexes, ALP-IgA and ALP-IgA-F(ab')₂, suggest that two molecules of monovalent ALP associated with one molecule of divalent IgA.     

Decrease by 50% of plasma IgA tissue transglutaminase antibody concentrations within 2 months after start of gluten-free diet in children with celiac disease used as a confirming diagnostic test

Background Histological examination of small bowel biopsies is normally the gold standard for the diagnosis of celiac disease (CD). The objective of this study was to investigate whether the rate of decreases in elevated plasma IgA tissue transglutaminase antibody (IgA-tTG) and/or IgG deamidated gliadin peptides antibody (IgG???DGP) concentrations could be used as a confirming test for CD in children on a gluten-free diet (GFD) when biopsy was omitted in the diagnostic process. Methods In this retrospective study we compared children (≤18 years old) with a CD-confirming biopsy (n?=?16) to children without a biopsy (n?=?18). After initiation of GFD the antibody half-life (the time (T_½) when the antibody concentration is 50% decreased) was determined in all children. Results Children with a biopsy (IgA-tTG, T_½?=?1.9 months; IgG???DGP, T_½?=?2.2 months) and children without a biopsy (IgA-tTG, T_½?=?1.6 months; IgG???DGP, T_½?=?2.7 months) had comparable T_½ (mean) results (p?Conclusions When biopsy was omitted a rapid rate of decrease in CD antibody concentrations confirmed the CD diagnosis in children on GFD. The half-lives (T_½) of IgA-tTG were less than 2 months in CD children.     

Immunoglobulin D-λ/λ biclonal multiple myeloma: A case report

BACKGROUNDImmunoglobulin D (IgD) multiple myeloma (MM) is a rare subtype of MM and commonly occurs in younger subjects but at a later stage of the International Staging System (ISS) when admitted. As a special type of IgD myeloma, IgD-λ/λ biclonal MM is rarer. Its serum protein electrophoresis and serum immuno-fixation electrophoresis (IFE) might find no anomalies even if the bone marrow (BM) examination is performed. Thus, it is easy to miss the diagnosis.CASE SUMMARYA 62-year-old man diagnosed as IgD-λ/λ myeloma (ISS stage III) was admitted with fatigue and weight loss. The physical examination suggested an anemic face, a few moist rales at the left lung base, and mild concave edema in both lower extremities. Laboratory examinations showed the elevated creatinine levels, β2-microglobulin, lactic dehydrogenase, and erythrocyte sedimentation rate, while the decreased neutrophils, granulocytes, and hemoglobin. In the serum protein electrophoresis, there appeared two inconspicuous M-spikes. Serum IFE indicated an over-representation of lambda light chain and yielded two monoclonal bands in λ region, but only one corresponding heavy chain band in the antisera to IgD region. The BM histology and BM cytology both supported the diagnosis of IgD-λ/λ myeloma.CONCLUSIONThis case highlights the differential clinical manifestations and laboratory findings of IgD-λ/λ myeloma to help minimize the chance of misdiagnosis.     

The use of immunohistochemistry for IgG4 in the diagnosis of autoimmune pancreatitis: A systematic review and meta-analysis

BackgroundThe diagnosis of autoimmune pancreatitis (AIP) remains challenging, especially when serum IgG4 is normal or imaging features are indeterminate. We performed a systematic review and meta-analysis to evaluate the performance of IgG4 immunostaining of pancreatic, biliary, and ampullary tissues as a diagnostic aid for AIP.MethodsA comprehensive literature search of the PubMed, EMBASE, and Ovid MEDLINE databases was conducted until February 2020. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. A random-effects model was used to summarize the diagnostic odds ratio and other measures of accuracy.ResultsThe meta-analysis included 20 studies comprising 346 patients with AIP and 590 patients with other pancreatobiliary diseases, including 371 pancreatobiliary malignancies. The summary estimates for tissue IgG4 in discriminating AIP and controls were as follows: diagnostic odds ratio 38.86 (95% confidence interval (CI), 18.70–80.75); sensitivity 0.64 (95% CI, 0.59–0.69); specificity 0.93 (95% CI, 0.91–0.95). The area under the curve was 0.939 for tissue IgG4 in discriminating AIP and controls. Subgroup analysis revealed no significant difference in diagnostic accuracy according to control groups (pancreatobiliary cancer versus other chronic pancreatitis) and sampling site (pancreas versus bile duct/ampulla).ConclusionsCurrent data demonstrate that IgG4 immunostaining of pancreatic, biliary, and ampullary tissue has a high specificity but moderate sensitivity for diagnosing AIP. IgG4 immunostaining may be useful in supporting a diagnosis of AIP when AIP is clinically suspected, but a combination of imaging and serology does not provide a conclusive diagnosis.     

Efficacy and limitations of the histological diagnosis of type 1 autoimmune pancreatitis with endoscopic ultrasound-guided fine needle biopsy with large tissue amounts

ObjectivesWe examined the efficacy and limitations of acquiring large specimens by endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for diagnosing type 1 autoimmune pancreatitis (AIP).MethodsPatients from 12 institutions with non-neoplastic diseases or pancreatic ductal adenocarcinoma (PDAC) with large EUS-FNB specimens were investigated. Slides stained with hematoxylin-eosin, elastic, IgG4, and IgG stains were evaluated. The IgG4- and IgG-positive cell numbers were counted in three foci. The diagnoses were based on the Japan Pancreas Society 2011 (JPS 2011) criteria and the International Consensus Diagnostic Criteria (ICDC).ResultsWe analyzed 85 non-neoplastic (definite type 1 AIP in 73/85 based on the ICDC) cases and 64 PDAC cases. IgG4-positive cells were numerous (>10 in 85.9%), and the IgG4/IgG ratios were high (>40% in 81.2%). Plasma cell crushing by an artifact caused unsuccessful immunostaining, notably in smaller samples. Tissue lengths were an important factor for the presence of storiform fibrosis and obliterative phlebitis, but storiform fibrosis was equivocal even in large tissues. A definite or possible histological diagnosis was achieved in 45.9% (39/85) and 41.2% (35/85), respectively, and contributed to the definite final diagnosis of type 1 AIP in 33.3% (ICDC) and 55.6% (JPS 2011) in cases with segmental/focal lesions. In the PDAC group, >10 IgG4-positive cells was rare (2/58), but elastic stains revealed fibrous venous occlusions in 10.3% (6/58).ConclusionsEUS-FNB with large tissue amounts was useful for diagnosing type 1 AIP, notably by facilitating successful IgG4 immunostaining, but definite diagnosis may not be achieved even in cases with large specimens.     

不同工艺制备的静注人免疫球蛋白产品质量对比研究

目的 对比用低温乙醇蛋白分离工艺制备的静注人免疫球蛋白（pH4）和两步阴离子交换层析制备的静注人免疫球蛋白（10%）产品质量指标,分析制备工艺对产品质量的影响。方法 对2种工艺的产品进行IgA含量、分子大小分布、抗-HBs效价、蛋白空间结构、Fc片段活性、抗体谱和IgG亚型分布等指标的检测和对比分析。结果 两步阴离子交换层析制备的静注人免疫球蛋白的IgA含量（5.30 μg/ml）明显低于低温乙醇分离制备的（281.95 μg/ml）,而分子大小分布、抗-HBs效价、蛋白空间结构、Fc片段活性、抗体谱、亚型分布指标没有明显差别。结论 两步阴离子交换层析制备的静注人免疫球蛋白（10%）具有更高的安全性。