邻苯二甲酐作业哮喘患者的免疫学观察

对10例PA作业哮喘患者进行免疫学指标观察。发现以苯酐为变应原的支气管激发试验(A-BPT)有半数阳性,其中双相反应3例,速发及迟缓反应各1例。血中抗原特异性IgE 及IG(S-IgE,S-IgG)分别有50%及80%阳性,与正常人对照有明显差异。本观察认为PA 哮喘在临床上基本符合一种变应性机制;但鉴于某些病例的非典型性,特别是体内存在较高水平的S-IgG 抗体,因此不能用单一的IgE 介导的速发型变态反应来解释。这种非典型病例更多的可能是一种慢性气道刺激反应以及体内IgG 型抗体增高的全身性反应。     

低浓度MDI、TDI对作业工人部分免疫功能影响的研究

目的　观察低浓度二苯基甲烷二异氰酸酯 (MDI)、甲苯二异氰酸酯 (TDI)对机体免疫系统的作用。方法　将接触MDI或TDI的工人分为MDI接触组 (Ⅰ、Ⅱ )、TDI接触组 (Ⅲ ) ,未接触过MDI、TDI的工人为对照组。各组均测定血清IgG、IgA、IgM、IgE和白介素 2受体 (IL 2R)浓度。同时MDI组、对照组测定血清中MDI特异性IgG、IgE水平和尿中MDA浓度。结果　MDI (Ⅰ )组的IgG、IgA均值明显低于对照组 (P <0 0 1)。TDI (Ⅲ )组的IgG、IgA、IgM均值明显高于对照组 ,且IL 2R水平明显升高 (P <0 0 1)。MDI接触组 (Ⅰ、Ⅱ )血清中MDI特异性IgG、IgE的阳性率随作业工龄的延长而增高 ,尿中MDA含量与血清中MDI特异性IgG水平有很好的相关性。结论　长期接触低浓度的MDI、TDI,多数人虽无明显的过敏症状 ,但机体免疫功能受到不同影响。血清MDI特异性IgG是接触人群的敏感生物标志物     

IgG_4、IgE抗体检测在过敏性疾病过敏源筛查中的应用

目的探讨特异性IgG4、IgE检测应用于过敏性疾病过敏源筛查的临床意义,为过敏性疾病诊断和预防提供科学依据。方法采用酶联免疫吸附法对120例过敏性疾病患者血清中14种常见过敏原特异性IgG4和IgE抗体进行平行检测。结果在120例过敏性疾病患者中,食物性过敏原特异性IgG4抗体阳性率为90.0%,特异性IgE抗体阳性率为94.2%,两者无显著差异(p>0.05);而吸入性过敏原的IgG4、IgE抗体阳性率分别为58.3%和74.2%,IgE阳性率显著较高(p<0.05)。食物性过敏原IgG4抗体阳性率也显著高于吸入性过敏原(p<0.05)。14种过敏原中,鸡蛋、小麦、梧桐的特异性IgG4阳性率显著高于IgE;而蟹、鳕鱼、虾、短豚草的特异性IgG4阳性率则显著低于IgE。结论应用特异性IgG4和IgE抗体联合检测诊断过敏原具有临床意义。     

乙二胺所致哮喘的临床免疫学研究

对5例EDA哮喘患者做了非特异性支气管激发试验,结果气道反应性轻度增高2例,中度增高3例。8例EDA哮喘患者做了特异性支气管激发试验,结果全部阳性,其中7例为迟发相反应,1例为双相反应。而普通哮喘组和正常对照组激发试验全部阴性。激发试验前后测定了总补体、组胺,作了嗜酸细胞计数。激发后EDA哮喘组嗜酸细胞明显增加,并有统计学意义(P<0.05),与普通哮喘组和正常对照组激发后嗜酸细胞计数比有显著差异(P<0.01)。EDA哮喘组激发后组胺释放增加(P<0.05)。EDA哮喘组总补体均未见有意义的改变。EDA-BSA皮内试验结果表明,EDA哮喘4例为阳性,普通哮喘组1例为阳性,而对照组无1例阳性。EDA-BSA作抗原,以酶联免疲分析证明了EDA哮喘组有3例有特异性IgG抗体,而其他两组未发现特异性IgG抗体,EDA哮喘组未检出特异性IgE抗体。     

食物变态反应性疾病原因筛查

目的分析过敏原特异性IgE、IgG在食物变态反应性疾病患者中的意义,为食物变态反应性疾病的防治提供依据。方法采用酶联免疫吸附实验（ELISA）方法检测食物过敏疾病患者血清中总IgE、食物特异性IgE、IgG。IgE检测283例,IgG检测120例。结果食物特异性IgG阳性101例,阳性率84.2%。血清总IgE检测276例,阳性率97.5%;食物特异性IgE阳性90例,阳性率31.8%。特异性IgE检测中鱼过敏原特异性IgE的阳性率最高,为12.0%。特异性IgG检测中蛋清/蛋黄IgG阳性率最高,为55%,其次为蟹35%,牛奶29.2%,虾25%。IgG抗体检测儿童与成人对食物过敏种类上存在明显差异,儿童以蛋清/蛋黄、牛奶为主,成人以蟹、虾为主。结论鱼、甲壳类（蟹、虾）、蛋清/蛋黄、牛奶是食物变态反应性疾病的主要过敏原。血清总IgE、食物特异性IgE、IgG抗体检测是食物变态反应性疾病比较可靠的筛查方法。     

血清特异性抗体测定在婴幼儿特应性皮炎致敏原检测中的意义

目的探讨血清特异性抗体测定在婴幼儿特应性皮炎致敏原检测中的意义,为临床婴幼儿特应性皮炎的诊治提供依据。方法选择2012-2014年湖南省儿童医院皮肤婴幼儿特应性皮炎80例作为特应性皮炎组,健康婴幼儿80例作为对照组。采用酶联免疫法测定血清中过敏原的IgG抗体和Ig E抗体情况。结果特应性皮炎组患者外源性过敏原IgG抗体检测阳性率比较高的有牛奶、鸡蛋和虾。特应性皮炎组患者鱼和虾特异性IgE抗体检测阳性率明显高于特异性IgG抗体检测阳性率(P0.05);特应性皮炎组患者牛奶、鸡蛋、大豆、小麦和猪肉特异性Ig E抗体检测阳性率与特异性IgG抗体检测阳性率之间没有明显差异(P0.05)。特应性皮炎组患者牛奶、鸡蛋特异性IgG抗体检测阳性率明显高于对照组(P0.05);特应性皮炎组患者大豆、鱼、虾、小麦和猪肉特异性IgG抗体检测阳性率与对照组之间比较没有明显差异(P0.05)。特应性皮炎组患者鸡蛋、牛奶、户尘螨、粉尘螨、虾特异性IgE抗体检测阳性率明显高于对照组(P0.05);特应性皮炎组患者大豆、鱼、小麦和猪肉特异性IgE抗体检测阳性率与对照组之间比较没有明显差异(P0.05)。结论 IgE抗体和IgG抗体的检测快速方便,能够有效地检测到特应性皮炎组的过敏原,在婴幼儿特应性皮炎的诊断和治疗中具有重要意义。     

食物过敏性疾病中血清特异性IgG与IgE抗体检测结果分析

目的探讨食物过敏性疾病中血清特异性IgG抗体与IgE抗体检测水平的临床意义。方法选择临床诊断为食物过敏性疾病患者100例,检测14种食物过敏原中血清特异性IgG与IgE抗体水平,分析2种特异性抗体在性别、年龄、食物种类的分布情况。结果14种食物过敏原特异性IgG抗体检测阳性率依次为牛奶(32.0%)、鸡蛋(29.0%)、大豆(18.0%)、大麦(18.0%)、小麦(18.0%)等;血清特异性IgE水平较高的依次是蟹(38.0%)、鳕鱼(20.0%)、牛奶(18.0%)等。血清特异性IgG抗体与IgE抗体阳性率在以上过敏原中检测率较高,且检出率不同;不同性别、年龄段2种抗体检测率也不同。结论牛奶、鸡蛋、大豆、蟹等容易引起食物过敏性疾病,特异性IgG、IgE抗体水平在不同食物引起的过敏性疾病中作用不同,差异较大,联合检测有益于过敏性疾病的准确判断。     

比较牛奶激发试验与血清特异性抗体诊断婴幼儿牛奶蛋白过敏的临床研究

目的 通过对牛奶激发试验与血清特异性抗体的比较,明确牛奶激发试验诊断婴幼儿牛奶蛋白过敏的临床意义。方法 收治苏州大学附属儿童医院2015年2-11月共57例疑似牛奶蛋白过敏的婴幼儿住院进行牛奶激发试验,并进行血常规检测,采用酶联免疫方法(ELISA)进行血清总IgE抗体、血清特异性牛奶蛋白IgE检测;采用免疫印迹法进行特异性牛奶蛋白IgG检测,比较和分析与激发结果的关系。结果 57例婴幼儿中牛奶激发试验阳性者占40.4%(23/34)。比较阳性组与阴性组的白细胞数、嗜酸性粒细胞比率、中性粒细胞比率、血小板计数变化,差异均无统计学意义(P＞0.05);仅有阳性组激发后中性粒细胞比率较激发前增高,差异有统计学意义(P=0.02);阳性组与阴性组的血清总IgE、特异性牛奶蛋白IgE及特异性牛奶蛋白IgG检测结果比较,差异无统计学意义(P＞0.05)。结论 对疑似牛奶蛋白过敏婴幼儿行血清总IgE及血清特异性牛奶蛋白IgE检测的临床意义不大,不推荐特异性牛奶蛋白IgG用于诊断牛奶蛋白过敏。应提倡牛奶激发试验应用于临床诊断婴幼儿牛奶蛋白过敏。     

反复呼吸道感染患儿食物特异性IgG抗体检测的临床意义

目的 探讨食物特异性IgG抗体检测在儿童反复呼吸道感染疾病中的临床使用意义。方法 选取开封市儿童医院2016年3月－2018年3月期间收治的门诊及住院经确诊的反复呼吸道感染患儿147例作为研究组,另选取同期进行体检的健康儿童110例作为对照组。采用酶联免疫法检测研究对象血清中牛肉、鸡肉、鱼、牛奶、蛋清/蛋黄、蟹、虾、大豆这8种食物特异性IgG抗体,分析两组儿童对食物特异性IgG的阳性率,并比较IgG阳性儿童血清中总IgE及嗜酸性粒细胞的阳性率。结果 研究组患儿的食物血清特异性IgG检出阳性率为73.5%,高于对照组正常儿童的18.2%(χ²=61.836,P<0.05);<3岁、3~<6岁及6~14岁年龄段,研究组的食物血清特异性IgG抗体阳性检出率分别为75.6%、81.3%及57.9%,均显著高于对照组(均P<0.05);研究组在牛奶、蛋清/蛋黄、蟹这三个食物过敏原的IgG检出阳性率为38.1%、57.8%、8.8%,均显著高于正常对照组(P<0.05);两组IgG阳性儿童中IgE及嗜酸性粒细胞检出阳性率结果差异无统计学意义(均P>0.05)。结论 食物特异性IgG抗体在反复呼吸道感染患儿中具有较高的阳性检出率,可以根据食物特异性IgG抗体的检测结果辅助反复呼吸道感染临床诊断和治疗。     

血清抗结核抗体对肺结核的诊断

目的 探讨血清抗结核抗体对肺结核诊断的作用。方法 以结核杆菌特异性外膜为抗原，斑点免疫金渗滤试验(DIGFA)原理随机检测本院2001年1月～2003年9月155例痰菌阳性和153例痰菌阴性肺结核病人的血清抗结核抗体，并以156例健康体检者为对照组。结果 痰菌阳性肺结核病人的血清抗结核抗体阳性率为80．6%，痰菌阴性肺结核病人的血清抗结核抗体阳性率为66．0%，健康对照组血清抗结核抗体阳性率为5．1％。肺结核病人的血清抗结核抗体阳性率明显高于健康对照组。结论 血清抗结核抗体对肺结核临床诊断有辅助参考价值。     

Humoral and cellular immune responses in asthmatic isocyanate workers: Report of two cases

Two workers (23 and 28 years old) developed rhinitis and bronchial asthma after occupational contact with the isocyanate MDI. Positive skin prick test results for MDI-HSA and IgE antibodies to all isocyanate-HSA conjugates were obtained in both cases, and the inhalation challenge test with MDI produced immediate and late asthmatic reactions. In the patch test and the stimulation assay of peripheral mononuclear blood cells, a specific sensitization to the diamine MDA (in both cases) and to further amines (in one case), as well as to hydrolysates of the respective diisocyanates, was seen, which appears to be independent of the IgE response to isocyanate-HSA conjugates. Our results offer evidence of IgE-mediated, as well as lymphocyte, responses induced by exposures to isocyanate products over several months or years. © 1996 Wiley-Liss, Inc.     

职业性哮喘的综合评价

对４３例可疑与职业有关的哮喘住院病例，进行了职业史、病史、物理检查，结合变应原支气管激发试验（Ａ－ＢＰＴ）、变应原皮试（ＳＴ）、特异性ＩｇＥ（Ｓ－ＩｇＥ）及特异性ＩｇＧ４（Ｓ－ＩｇＧ４）等项检查。结果表明：Ａ－ＢＰＴ阳性率６７．４％，阳性组的ＳＴ、Ｓ－ＩｇＥ、Ｓ－ＩｇＧ４阳性率分别为５３．０％，５４．５％和５９．０％，明显高于激发阴性组。ＳＴ、Ｓ－ｌｇＥ、Ｓ－ＩｇＧ４与Ａ－ＢＰＴ的符合率分别为７１．０％，６９．４％及７３．９％，Ｓ－ＩｇＥ与Ｓ－ｌｇＧ４符合率为７８．３％。以上指标在评价职业病因方面具有明显的特异性与敏感性，几项指标的综合分析，则能极大地提高病因诊断的正确性与阳性率。     

牛奶蛋白过敏婴儿血清IL-10及TGF-β水平的表达研究

目的 比较牛奶蛋白过敏婴儿血清IL-10及TGF-β水平,分析其在婴儿牛奶蛋白过敏中的作用。 方法 选取2018年1-6月在深圳市妇幼保健院住院经回避激发试验确诊为牛奶蛋白过敏患儿20例为牛奶蛋白过敏组,选取同期健康婴儿15例作为对照组,采用ELISA检测两组婴儿血清IL-10、TGF-β及IgG4水平,同时检测食物过敏原总IgE以及牛奶特异性IgE。 结果 牛奶蛋白过敏组总IgE＞200者5例,总IgE 100～200者2例,总IgE＜100者13例。血清IL-10、TGF-β及IgG4水平均较对照组降低(t=-3.130、-2.811、-3.463,P＜0.05)。在牛奶蛋白过敏组中,IgE阳性亚组与IgE阴性亚组IgG4水平比较,差异无统计学意义(t=-0.781,P＞0.05)。 结论 IL-10及TGF-β在婴儿牛奶蛋白过敏的发病中起重要作用,IgG4与IgE可能无关。动态观察IL-10及TGF-β水平变化,对尽早了解牛奶蛋白过敏婴儿疾病的转归或耐受有积极作用。     

甲苯二异氰酸甲酯所致支气管哮喘患者的支气管激发试验及免疫学研究

对18例临床上诊断为支气管哮喘的TDI作业者进行变应原BPT,并与其它免疫学指标对比观察。发现BPT阳性14例(占77.8％),其中速发反应7例,迟缓反应6例,双相反应1例。BPT阳性者的肺功能指标FVC、FEV_1、MMF、PF、V_(75)、V_(50)、V_(25)等均有明显降低。免疫指标中以IgA、特异性IgE的增高为著,各占7例及9例,并与BPT阳性反应相一致。以上证明了TDI哮喘的变态反应机理,特别是与IgE介导的速发型反应有关。此外,BPT作为一种病因诊断手段,有明显的特异性及实用性。     

Quantitative skin prick and bronchial provocation tests with platinum salt.

Occupational asthma due to platinum salts is a frequent disease in platinum refineries. The diagnosis is based upon a history of work related symptoms and a positive skin prick test with platinum salts. Bronchial provocation tests have not been performed in epidemiological studies because the skin test is believed to be highly specific and sensitive. As no reliable data about this issue currently exist, this study assesses the use of skin prick and bronchial provocation tests with methacholine and platinum salt in platinum refinery workers. Twenty seven of 35 workers, who were referred to our clinic with work related symptoms and nine control subjects with bronchial hyperreactivity underwent a skin prick test and bronchial provocation with methacholine and platinum salt. For skin prick and bronchial provocation tests with platinum salt a 10(-2)-10(-8) mol/l hexachloroplatinic acid solution, in 10-fold dilutions was used. Four of the 27 subjects and all controls showed neither a bronchial reaction nor a skin reaction. Twenty three subjects were considered allergic to platinum salt; 22 of these showed a fall of 50% or more in specific airway conductance after inhalation of the platinum salt solution. Four workers experienced a positive bronchial reaction despite a negative skin prick test. No correlation of responsiveness to methacholine with responsiveness to platinum salt was found, but the skin prick test correlated with the bronchial reaction to platinum salt (rs = 0.50, p less than 0.023, n = 22). One dual reaction was seen in bronchial provocation tests. Side effects of both skin tests and bronchial provocation tests with platinum salt were rare and were not encountered in workers without a skin reaction to platinum salt. It is concluded that bronchial provocation tests with platinum salts should be performed on workers with work related symptoms but negative skin tests with platinum salts.     

Quantitative skin prick and bronchial provocation tests with platinum salt.

Occupational asthma due to platinum salts is a frequent disease in platinum refineries. The diagnosis is based upon a history of work related symptoms and a positive skin prick test with platinum salts. Bronchial provocation tests have not been performed in epidemiological studies because the skin test is believed to be highly specific and sensitive. As no reliable data about this issue currently exist, this study assesses the use of skin prick and bronchial provocation tests with methacholine and platinum salt in platinum refinery workers. Twenty seven of 35 workers, who were referred to our clinic with work related symptoms and nine control subjects with bronchial hyperreactivity underwent a skin prick test and bronchial provocation with methacholine and platinum salt. For skin prick and bronchial provocation tests with platinum salt a 10(-2)-10(-8) mol/l hexachloroplatinic acid solution, in 10-fold dilutions was used. Four of the 27 subjects and all controls showed neither a bronchial reaction nor a skin reaction. Twenty three subjects were considered allergic to platinum salt; 22 of these showed a fall of 50% or more in specific airway conductance after inhalation of the platinum salt solution. Four workers experienced a positive bronchial reaction despite a negative skin prick test. No correlation of responsiveness to methacholine with responsiveness to platinum salt was found, but the skin prick test correlated with the bronchial reaction to platinum salt (rs = 0.50, p less than 0.023, n = 22). One dual reaction was seen in bronchial provocation tests. Side effects of both skin tests and bronchial provocation tests with platinum salt were rare and were not encountered in workers without a skin reaction to platinum salt. It is concluded that bronchial provocation tests with platinum salts should be performed on workers with work related symptoms but negative skin tests with platinum salts.     

Challenge from methacholine, natural rubber latex, or 4,4′-diphenylmethane diisocyanate in workers with suspected sensitization affects exhaled nitric oxide [change in exhaled NO levels after allergen challenges]

Objective: Nitric oxide (NO) levels in the exhaled air of asthmatic patients have been shown to be increased. This observation has also been reported in workers who are allergic to laboratory animals. To determine if a challenge test with natural rubber latex (NRL) or 4,4′-diphenylmethane diisocyanate (MDI) would also produce an increase of NO exhalation in sensitized patients, we carried out this study. Methods: Nine subjects with suspected occupational asthma were exposed to MDI, and 18 took part in a challenge test with gloves powdered with NRL. Nineteen subjects underwent a challenge test with methacholine (MCh). Exhaled NO was measured by a modified chemiluminescence analyzer according to the European Respiratory Society guidelines. Results: We found that there was a decrease in exhaled NO concentrations 16–18 h after MCh challenge testing and subsequent bronchodilation with salbutamol, in three subjects. Three of nine participants had a significant immediate bronchial obstruction after exposure to MDI, of those three, two had MDI-specific IgE antibodies. After 22 h, their levels of exhaled NO had increased >10 parts per billion (ppb). Eight of the 18 subjects participating in the NRL challenge test displayed an NO concentration increase of at least 10 ppb after 22 h (seven had NRL-specific IgE antibodies). A significant decrease in the one-second forced expiratory volume (FEV₁) was documented in four of those eight participants after NRL challenge. Conclusions: There was no clear relationship between bronchial response, substance-specific IgE antibodies and an increase in exhaled NO levels. However, there was a tendency for subjects with substance-specific IgE antibodies and bronchial reaction to develop an increase in exhaled NO concentration. Further studies are needed to determine if analysis of NO from the lower respiratory tract can become a useful non-invasive tool for detecting lower airway inflammatory response even before clinical symptoms occur. Received: 19 May 1999 / Accepted: 20 November 1999     

Isocyanate-induced asthma: results of inhalation tests with TDI,MDI and methacholine

Summary We performed diisocyanate inhalation tests (maximal concentration, 20 ppb; exposure time, 1–2h) using toluene diisocyanate (TDI, n = 15) and diphenylmethane diisocyanate(MDI, n = 7) as well as methacholine challenges in 19 workers who had a clinical history of TDI/MDI-induced asthma. Additionally we tested volunteers who had no previous contact with diisocyanates: 10 healthy individuals with a negative methacholine test and 14 patients with asthma and a positive methacholine test were exposed to TDI. In all, 1 of the normal volunteers and 3 of the patients with asthma unrelated to diisocyanates showed a positive airway reaction to TDI, and 13 of the 19 diisocyanate workers displayed a positive result in the TDI/MDI inhalation test; however, only 6 of these 13 individuals reacted to methacholine. Furthermore, 3 of the 6 patients with a negative TDI/MDI challenge test demonstrated a significant response to methacholine. We conclude that bronchial hyperreactivity as evaluated by the methacholine challenge test is not closely related to isocyanate-induced bronchoconstriction and, therefore, the metacholine challenge is only of limited diagnostic value in patients with suspected isocyanate-induced asthma.This work was supported by grant 07 ALL 016 from the BMFT (FRG)