危重型毛细支气管炎抢救体会：附31例分析

231例毛细支气管炎,危重型38例占16.4％,抢救成功31例占81.6％。本文讨论了危重型毛细支气管炎并多器官功能衰竭的发生与预后及平喘药物的合理选用。认为早期应用免疫疗法、迅速平喘、保护重要器官功能及合理治疗并存症是抢救成功的关键。     

Comparison of allergenicity and immunogenicity of an intact allergen vaccine and commercially available allergoid products for birch pollen immunotherapy

BACKGROUND: Specific immunotherapy with intact allergen vaccine is a well-documented treatment for allergic diseases. Different vaccine formulations are currently commercially available, the active ingredient either being intact allergens or chemically modified allergoids. The rationale behind allergoids is to decrease allergenicity while maintaining immunogenicity. However, data from the German health authorities based on reporting of adverse events over a 10-year period did not indicate increased safety of allergoids over intact allergens. OBJECTIVE: The objective of this study was to investigate the effect of chemical modification on allergenicity and immunogenicity comparing four commercial allergoid products for birch pollen immunotherapy with an intact allergen vaccine. METHODS: Solid-phase IgE inhibition and histamine release assays were selected as model systems for allergenicity, and a combination of human T cell proliferation and IgG titres following mouse immunizations were used to address the immunogenicity of the intact allergen vaccine and the four allergoids. In all assays, the products were normalized with respect to the manufacturer's recommended maintenance dose. RESULTS: IgE inhibition experiments showed a change in epitope composition comparing intact allergen vaccine with allergoid. One allergoid product induced enhanced histamine release compared to the intact allergens, while the other three allergoids showed reduced release. Standard T cell stimulation assays using lines from allergic patients showed a reduced response for all allergoids compared with the intact allergen vaccine regardless of the cell type used for antigen presentation. All allergoids showed reduced capacity to induce allergen-specific IgG responses in mice. CONCLUSION: While some allergoids were associated with reduced allergenicity, a clear reduction in immunogenicity was observed for all allergoid products compared with the intact allergen vaccine, and the commercial allergoids tested therefore do not fulfil the allergoid concept.     

主动免疫恢复T辅助细胞平衡治疗习惯性流产

目的:寻求安全、有效地治疗不明原因习惯性流产(UHA)的方法,并探讨主动免疫治疗前后的细胞因子的免疫功能变化及T辅助细胞的平衡状态。方法:①对35例UHA患者采用丈夫肘静脉血20 m l分离淋巴细胞行主动免疫治疗(妊娠前治疗两次,妊娠后治疗两次);②采用酶联免疫吸附方法对68例UHA患者及30例正常妇女外周血IL-2、IL-4、IL-10、IFN进行检测;③对29例主动免疫后妊娠成功者治疗前后的IL-2、IL-10、Th1/Th2进行检测。结果:①主动免疫组33例妊娠,妊娠成功并分娩29例,妊娠成功率87.88%(29/33),未经主动免疫治疗的对照组妊娠成功率26.67%(8/30),两组相比差异有显著性(P<0.010);②68例UHA患者较正常妇女外周血中IL-2明显升高(P<0.01),IL-10降低(P<0.05),Th1/Th2比值增高(P<0.05);③29例UHA患者主动免疫治疗后妊娠成功者IL-10显著上升(P<0.1),Th1/Th2比值下降(P<0.05)。结论:UHA患者Th1、Th2平衡异常,主动免疫治疗可诱导Th1向Th2转移,恢复Th1、Th2之间的平衡,可用于UHA的治疗。     

老年人免疫功能异常变化的临床观察及其评价(Ⅰ)

老年人生理适应与防卫能力进行性下降,对有害因子易伤性增加,导致多种老年病的发生。因此,免疫系统功能与衰老的关系问题,已是现代老年病学和免疫学进行多方深入研究的重要内容。我们近两年多来对老年人免疫功能变化做了临床观察检测与统计分析。现报告如下。 1.临床资料     

Preservation and redirection of HPV16E7-specific T cell receptors for immunotherapy of cervical cancer

Human papilloma virus (HPV) type 16 infections of the genital tract are associated with the development of cervical cancer (CxCa) in women. HPV16-derived oncoproteins E6 and E7 are expressed constitutively in these lesions and might therefore be attractive candidates for T-cell-mediated adoptive immunotherapy. However, the low precursor frequency of HPV16E7-specific T cells in patients and healthy donors hampers routine isolation of these cells for adoptive transfer. To overcome this problem, we have isolated T cell receptor (TCR) genes from four different HPV16E7-specific healthy donor and patient-derived human cytotoxic T lymphocyte (CTL) clones. We examined whether genetic engineering of peripheral blood-derived CD8+ T cells in order to express HPV16E711-20-specific TCRs is feasible for adoptive transfer purposes. Reporter cells (Jurkat/MA) carrying a transgenic TCR were shown to bind relevant but not irrelevant tetramers. Moreover, these TCR-transgenic Jurkat/MA cells showed reactivity towards relevant target cells, indicating proper functional activity of the TCRs isolated from already available T cell clones. We next introduced an HPV16E711-20-specific TCR into blood-derived, CD8+ recipient T cells. Transgenic CTL clones stained positive for tetramers presenting the relevant HPV16E711-20 epitope and biological activity of the TCR in transduced CTL was confirmed by lytic activity and by interferon (IFN)-gamma secretion upon antigen-specific stimulation. Importantly, we show recognition of the endogenously processed and HLA-A2 presented HPV16E711-20 CTL epitope by A9-TCR-transgenic T cells. Collectively, our data indicate that HPV16E7 TCR gene transfer is feasible as an alternative strategy to generate human HPV16E7-specific T cells for the treatment of patients suffering from cervical cancer and other HPV16-induced malignancies.     

Transfer factor (TF) treatment of patients with HBs-Ag-positive chronic active hepatitis

Summary It is a clinically and experimentally well supported working hypothesis that infection with hepatitis B virus may result in chronic active hepatitis in patients with suspected immune deficiencies. On this basis, a pilot study was performed in order to evaluate the effect of specific transfer factor (TF) in the treatment of HB_s-Ag-positive chronic active hepatitis. From the leukocytes of 500 ml venous blood each of 40 volunteers that had completely recovered from acute virus hepatitis B within the last 6 months, a unique TF pool (40 units of TF) was prepared according to the method of Lawrence. Preexaminations indicated that this preparation was able to enhance cellular immune reactions in vitro. Thirteen patients with HB_s-antigenemia and chronic active hepatitis (i.e., two liver biopsies within the last 6 or more months with the histological criteria of chronic aggressive hepatitis according to de Groote, elevated serum levels of bilirubin, alkaline phosphatase, transaminase activities, and/or -globulines) were randomized: Seven received s.c. injections of two units of TF each on days 1 and 15, the other six saline. Conversion of skin reactions to some ubiquitous antigens occurred in the TF group, but no significant and constant drop of HB_s-Ag serum titers was observed. Although some of the biochemical parameters seemed to ameliorate in the TF group, the differences versus the control group did not prove to be significant within the limited number of patients under observation. The in vitro reactivity of patients' lymphocytes to HB_s-Ag, tested by means of the³H-thymidine uptake, was never found enhanced after TF application. In the used doses, specific TF was not effective in the treatment of HB_s-Ag-positive chronic active hepatitis; unfavorable side-effects were not observed.     

转染肿瘤总RNA的DC疫苗诱导抗肝癌特异性免疫

目的：探讨转染人肝癌总RNA的树突状细胞(DC) 疫苗体外诱导特异性细胞毒性T淋巴细胞(CTL)的作用。 方法： 采用原发性肝癌（HCC）病人外周血单核细胞（PBMC），在粒/巨细胞集落刺激因子(GM-CSF)和白细胞介素-4(IL-4) 刺激下增殖分化为DC细胞；从人肝癌细胞中体外扩增肝癌RNA。以HCCRNA转染DC细胞，并与PBMC混合培养诱导扩增CTL。MTT法测定CTL的杀瘤活性。 结果： 转染HCCRNA 48 h后， DC表面分子CD83、CD86和HLA-DR表达明显增高。转染HepG-2细胞HCCRNA的DC和病人HCCRNA诱导的CTL对HepG-2细胞和病人HCC细胞的杀瘤活性均明显高于正常肝细胞RNA+DC、脂质体+DC、Opti-MEM+DC以及空白对照组；而对胃癌SGC-7901细胞无杀伤活性。 结论： 以肝癌RNA为肿瘤抗原，DC作为疫苗的抗原提呈细胞，体外冲击致敏DCs，能诱导肝癌特异性CTL。本研究为HCC术后复发和转移的防治提供一种可能有效的疫苗治疗方法。     

IL-18基因修饰增强肿瘤抗原多肽致敏的树突状细胞体内诱导的抗肿瘤免疫反应

目的 :研究肿瘤抗原多肽致敏的白细胞介素 18(IL 18)基因修饰的树突状细胞体内诱导的抗肿瘤免疫反应。方法 :①以Lewis 3LL肺癌细胞特异性抗原肽mut1冲击致敏IL 18基因修饰的骨髓来源的树突状细胞 (DC IL 18 mut1) ,每次用其 1× 10 5 只皮下免疫小鼠 2次 ,然后测定脾细胞的NK活性及CTL杀伤活性 ;②以DC IL 18 mut1每次 2× 10 5 只皮下免疫 1次 ,然后再以 5× 10 53LL细胞攻击 ,在诱导及效应阶段分别以单抗阻断不同免疫成份 ,观察肿瘤的生长。结果 :以DC IL 18 mut1皮下免疫后可诱导出比DC mut1等免疫组更高水平的 3LL肺癌细胞特异性CTL ,并使NK活性明显增加 ;单抗体内阻断实验提示在DC IL 18 mut1免疫诱导阶段 ,CD4 + T细胞和抗原共刺激分子、IFN γ均起到重要作用 ,而效应阶段CD8+ T、IFN γ、NK起作用 ,而CD4 + T则是非必需的。结论 :DC IL 18 mut1皮下免疫后可诱导高水平的抗肿瘤免疫活性 ,其机理与抗原有效提呈、特异性CTL诱导、NK活性增加以及CD4 + 、CD8+ T、NK细胞、IFN γ参与密切相关。