The place of intravenous immunoglobulin (IgG i.v.) therapy in thrombocytopenia

Summary Acute ITP following infection in children has a high rate of spontaneous remission. Since the platelet count is not uncommonly profoundly depressed, ITP is associated with a mortality of around 1%. The aim of treatment in ITP is to prevent bleeding. As a rule, this can only be achieved by normalizing the platelet count. Intravenous immunoglobulin offers certain advantages over conventional steroid therapy. Moreover, two out of three patients with chronic ITP respond to IgG i.v. The characteristic features of ITP in pregnancy, thrombocytopenia in babies born to mothers with ITP and neonatal isoimmune thrombocytopenia are discussed.     

支气管哮喘与免疫调节

支气管哮喘(哮喘)是由环境过敏原引起基因易感人群Th1/Th2免疫失衡,Th2功能亢进而引起的.产生Th2细胞因子的CD4+T细胞在哮喘发生过程中起了关键的作用[1].各种特异性致炎因子,调节性T细胞,抗原呈递细胞以及免疫球蛋白(Ig)都参与了哮喘的发生,本文就哮喘与免疫调节的关系以及免疫治疗的前景作一综述.     

天津某医院严重急性呼吸综合征暴发期间血清流行病学调查

目的 研究本院严重SARS暴发流行后，疫源地不同人群血清SARS冠状病毒（SARS-CoV）抗体水平及其产生和变化规律；探讨人群SARS-CoV隐性感染和IgG抗体的保护作用。方法 采用血清流行病学法，联合运用ELISA和免疫荧光试验（IFA），调查疫情暴发流行期间及流行后，疫源地内非SARS人群血清抗体水平变化；定性研究SARS患者病后6周内IgM、IgG抗体产生和变化规律；动态观察SARS患者康复期82周内IgG抗体水平变化规律。结果 各100例疫源地一般人群和非疫源地对照人群血清SARS-CoV IgG抗体ELISA抽样检测均为阴性；487例SARS高危人群血清SARS-CoV IgG抗体ELISA检测阳性率为0．41％，经IFA复核后均为阴性；疫源地内非SARS人群IgG抗体A值水平在疫情流行后高于流行期间，差异有统计学意义（P〈0．05）；SARS患者病后1～6周血清抗体IgM和IgG的阳性检出率分别为7．7％、40．0％、57．8％、88．2％、76．6％、57．1％和0、23．1％、48．4％、65．4％、77．8％、100．0％；SARS患者康复期血清IgG抗体A值逐渐增高，病后第22周达到高峰，此后缓慢下降，第82周时仍维持较高水平，下降趋势减缓。结论 SARS可能不存在隐性感染者；绝大多数SARS患者在急性期或恢复早期的血清中存在IgM抗体，其出现较早，消失也较快，抗体IgG出现稍晚，但在血清中存在时间较长，达到高峰后消退缓慢，提示该抗体可能具有保护作用。     

利用独特型——抗独特型理论检测Graves病患者血清中异常免疫球蛋白

根据体外放射分析的原理及独特型——抗独特型理论,利用抗TSH抗体作为结合剂,放射性碘标记的金黄色葡萄球菌A蛋白(~(125)I-SPA)作为定量的示踪剂,建立一种新的检测 Graves病(GD)患者血清中的异常免疫球蛋白(aIgG)的方法,进行了有关方法学的初步研究,探索了TSHAb与aIgG反应的最适反应条件,并与以神经节苷脂为结合剂的酶联免疫吸附分析法(ELISA)作了比较.探讨了aIgG与甲状腺刺激性免疫球蛋白(TSI)的关系.结果显示:TSHAb与GD患者血清中aIgG在体外能够发生特异性结合,而与正常人血清中的IgG、系统性红班狼疮(SLE)患者IgG及糖尿病(DM)患者IgG不发生结合反应.在以aIgG指数作为评价指标时,29名正常人血清aIgG指数为1.06±0.17,其正常范围上限为1.39,在以大于1.39作为阳性时,72名不同临床时期GD患者,初发组阳性率为83%(n=24),临床缓解组阳性率为12%(n=25),复发组阳性率为82%(n=23).正常人血清aIgG指数值与GD初发患者及GD复发患者相比,差异具有极显著性(P<0.001).我们认为本法能较好检出该类aIgG,可用于反映GD患者免疫状况,鉴别诊断及预测治疗缓解后复发的有用指标.     

特异性异尖线幼虫感染IgE抗体阳性与高危妊娠的相关性分析

【目的】探讨异尖线幼虫感染IgE抗体阳性与高危妊娠的相关性。【方法】选择2017年1月至2019年12月在本院诊治的高危妊娠孕妇738例(观察组),另外选择同期在本院产检健康孕妇500例作为对照组。采集所有孕妇的静脉血,检测其血清特异性异尖线幼虫IgE抗体,并分析孕妇血清IgE抗体阳性的影响因素及与高危妊娘的相关性。【结果】观察组IgE抗体阳性率为24.8%(183/738),显著高于对照组的20.0%(100/500),其差异有统计学意义(P<0.05);IgE阳性组孕妇的平均年龄显著大于IgE阴性组,顺产比例、初产比例显著低于IgE阴性组,产后住院时间显著长于IgE阴性组,妊娠期间检查次数显著少于IgE阴性组。孕妇分娩的新生儿中,IgE阳性组孕妇所产的新生儿体质量、胎龄均显著小于IgE阴性组,新生儿监护病房(NICU)患儿比例显著高于IgE阴性组。高危妊娠是孕妇异尖线幼虫感染IgE抗体阳性的独立危险因素。【结论】高危妊娠是孕妇异尖线幼虫感染IgE抗体阳性的独立危险因素,影响妊娘结局。     

Effects of mental workload on long-latency auditory-evoked-potential,salivary cortisol,and immunoglobulin A

This paper researches on the effects of mental workload on long-latency auditory-evoked-potential (AEP), salivary cortisol, and immunoglobulin A (IgA). 20 Healthy subjects (11 males and 9 females) participated in the experiment voluntarily. The mental task consisted of two parts: arithmetic task and reading comprehension task. The Latencies of N1, P2, N2, P3, and mismatch negativity (MMN) all increased significantly after the mental tasks were adopted at all of the three recording sites: Cz, Fz, and Pz (p < 0.05). In this experiment, changes of salivary cortisol and s-IgA levels due to mental tasks were not significant. With the introduction of mental tasks, more processing resources are allocated to the primary task (mental task), and decreased processing resources available for the secondary task (auditory task), which is reflected on the increases in the latencies of probe-evoked AEP components.     

Total IgE plasma levels vary according to gender and age in Brazilian patients with allergic rhinitis

OBJECTIVE:

Allergic rhinitis is a disease that affects the upper airways and causes inflammation of the nasal mucosa and it is mediated by IgE antibodies produced after sensitization to environmental allergens. Previous reports have indicated that this disease affects males more often than females. The objective of this study was to verify whether total IgE plasma levels vary between genders in patients suffering from allergic rhinitis.

METHODS:

A total of 171 adult patients suffering from allergic rhinitis (55 males and 116 females) were enrolled. Total IgE plasma levels were determined using commercial kits, with 140 IU/mL considered as a reference value. The mean total IgE plasma levels were compared according to gender and age.

RESULTS:

The mean age of the overall patient group with allergic rhinitis was 38.4±19.0 years and a significant difference in age was observed between genders (males: 32.2±17.8 years; females: 41.4±18.9 years; p = 0.0027). Additionally, the mean total IgE plasma levels were higher in males (413.0±143.0 IU/mL) than in females (147.9±98.0 IU/mL) (p<0.0001). These differences persisted even when males and females were stratified by age (up to or older than 20 years of age).

CONCLUSIONS:

In conclusion, total IgE plasma levels are higher in young adult males than in females suffering from allergic rhinitis. Evaluating total IgE plasma levels can be useful to identify patients at risk of allergic rhinitis in areas with low industrial pollution.     

Recent advances in the management of autoimmune pancreatitis in the era of artificial intelligence

Autoimmune pancreatitis (AIP) is a type of immune-mediated pancreatitis subdivided into two subtypes, type 1 and type 2 AIP. Furthermore, type 1 AIP is considered to be the pancreatic manifestation of the immunoglobulin G4 (IgG4)-related disease. Nowadays, AIP is increasingly researched and recognized, although its diagnosis represents a challenge for several reasons: False positive ultrasound-guided cytological samples for a neoplastic process, difficult to interpret levels of IgG4, the absence of biological markers to diagnose type 2 AIP, and the challenging clinical identification of atypical forms. Furthermore, 60% and 78% of type 1 and type 2 AIP, respectively, are retrospectively diagnosed on surgical specimens of resected pancreas for suspected cancer. As distinguishing AIP from pancreatic ductal adenocarcinoma can be challenging, obtaining a definitive diagnosis can therefore prove difficult, since endoscopic ultrasound fine-needle aspiration or biopsy of the pancreas are suboptimal. This paper focuses on recent innovations in the management of AIP with regard to the use of artificial intelligence, new serum markers, and new therapeutic approaches, while it also outlines the current management recommendations. A better knowledge of AIP can reduce the recourse to surgery and avoid its overuse, although such an approach requires close collaboration between gastroenterologists, surgeons and radiologists. Better knowledge on AIP and IgG4-related disease remains necessary to diagnose and manage patients.