肺炎衣原体感染与偏头痛的关系

目的探讨慢性肺炎衣原体（CPn）感染与偏头痛的关系。方法所有病例分为观察组（56例）与对照组（30例）。肺炎衣原体血清特异性IgG、IgM抗体采用酶联免疫吸附试验法，血清胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）浓度检测采用全自动生化仪。结果观察组和对照组肺炎衣原体感染率分别为62.50％和36．67％，差异有统计学意义（P〈0．05）。结论偏头痛患者肺炎衣原体感染率明显增高，肺炎衣原体感染与偏头痛有关，可能是偏头痛发作的病因之一，深入研究可能探索偏头痛的发病机制及防治新途径。     

脑脊液、血清免疫球蛋白及脑脊液寡克隆区带对自身免疫性脑炎的诊断意义

目的：探讨脑脊液、血清免疫球蛋白及脑脊液寡克隆区带（OCB）对自身免疫性脑炎（AE）的诊断意义。方法前瞻性收集2014年3月～2016年3月 AE 患者12例，以同期病毒性脑炎（VE）28例，多发性硬化（MS）16例为对照。 AE 患者予以 AE 抗体筛查，测定3组 CSF 中 IgG 及血清 IgG 、IgA 、IgM 浓度，计算 IgG 指数，检测血清及脑脊液 OCB 。所有入组患者均予以 MR 及脑电图等检查。结果 AE 及 MS 组 IgG 指数及 CSF － IgG 均高于 VE 组，AE 组高于 MS 组（P ＜0．05）；AE 及 MS 组血清 IgG 均高于 VE 组，IgM 低于 VE 组（P ＜0．05），AE 组与 MS 组差异无统计学意义（P ＞0．05）；3组患者血清 IgA 水平差异无统计学意义（P ＞0．05）；脑脊液 OCB 阳性率，VE 组7．14％，MS 组62.50％，AE 组91．67％，AE 组高于 MS 组、VE 组（χ2＝13．75，P ＜0．05）。 IgG 指数＞0．7百分率，VE 7．14％，MS 组62．50％，AE 组91．66％，3组比较差异有统计学意义（χ2＝25．61，P ＜0．05）。3组 MR影像学表现，VE 多累及颞叶、额叶，AE 多累及颞叶、顶叶、枕叶、脑岛，多呈双侧对称性或多发性。 MS多分布在脑室周围白质、视神经、脊髓、脑干和小脑。结论 AE 患者鞘内蛋白合成增加，脑脊液 OCB及 IgG 指数对 AE 早期的诊断有一定意义。     

脑血管病患者血清肺炎衣原体抗体的检测及病因探讨

目的:通过检测脑梗死组、脑出血组和正常对照组血清肺炎衣原体抗体IgM、IgG、IgA的滴度,及血脂水平、纤维蛋白原和C-反应蛋白浓度,来探讨肺炎衣原体感染在脑血管病发病中的作用和致病机理。方法:用间接酶联免疫吸附试验(ELISA)法,测定血清肺炎衣原休抗体IgM、IgG、IgA。用速率比浊散射法测定血清中C-反应蛋白浓度。结果:脑梗死组血清肺炎衣原体抗体IgA的阳性率为57.5％与对照组28％相比,差别有统计学意义(P<0.05)。脑出血组抗体IgA阳性率56％与对照组28％相比,差别有统计学意义(P<0.05)。而脑梗死组和脑出血组抗体IgA阳性率无差别(P>0.05)。余肺炎衣原体抗体IgM、IgG三组之间均无差别(P>0.05)。肺炎衣原体抗体IgA滴度(OD值)与C-反应蛋白浓度成正相关r=0.72(95％C10.61-1.21P<0.01)。结论:肺炎衣原体的慢性活动性感染或重复感染是引起动脉粥样硬化性脑梗死和脑出血的危险因素,其机理可能为免疫炎症机制损伤血管壁,导致动脉粥样硬化的形成。     

寡克隆区带和IgG指数在多发性硬化中的诊断意义

目的研究寡克隆区带（OCBs）和IgG指数（IgGI）对多发性硬化（MS）诊断的敏感性及其影响因素。方法用等电聚焦结合银染色法检测30例MS、40例神经系统炎性疾病（NID）和22例神经系统非炎性疾病（NNID）患者CSF中OCBs，并计算IgG I。结果MS组和NID组比较OCBs阳性率、IgG I异常率均无显著性差异（P〉0．05）；MS组、NID组与NNID组比较。差异均有显著性（P〈0．05）；传统型MS和脊髓型MS比较，差异均无显著性（P〉0．05）。OCBs对MS诊断的敏感性、特异性和阳性结果似然比分别为63．3％、77．7％和2．8；IgG I分别为40．0％、76．7％和1．7。结论本地区MSOCBs阳性率和IgG I异常率较低，可能与遗传背景、疾病类型和药物应用有关，OCBs和IgG I对MS诊断具有相对特异性。     

肺炎衣原体感染与偏头痛的关系

目的探讨慢性肺炎衣原体(CPn)感染与偏头痛的关系。方法所有病例分为观察组(56例)与对照组(30例)。肺炎衣原体血清特异性IgG、IgM抗体采用酶联免疫吸附试验法,血清胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)浓度检测采用全自动生化仪。结果观察组和对照组肺炎衣原体感染率分别为62.50%和36.67%,差异有统计学意义(P<0.05)。结论偏头痛患者肺炎衣原体感染率明显增高,肺炎衣原体感染与偏头痛有关,可能是偏头痛发作的病因之一,深入研究可能探索偏头痛的发病机制及防治新途径。     

精神分裂症首次发病患者弓形虫感染率及其对临床症状的影响

目的探讨弓形虫感染与精神分裂症发病的关系，调查精神分裂症首次发病（以下简称首发）患者及其母亲弓形虫抗体阳性率，了解弓形虫抗体阳性与阴性患者在临床症状上的异同。方法采用酶联免疫吸附法，检测600例首发精神分裂症患者（患者组）、252例患者的母亲（患者母亲组）、正常对照组（200名）和非精神疾病的疾病对照组（200例）血清弓形虫抗体水平，并对患者组进行阳性和阴性症状量表评定。结果（1）IgG和IgM抗体阳性率，患者组分别为13．7％和5．3％，高于合并对照组（即正常对照组合并疾病对照组；分别为3．8％和2．8％；P〈0．01和P〈0．05）；患者母亲组分别为19．4％和9．1％，高于患者组和合并对照组（P〈0．01和P〈0．05）。（2）弓形虫抗体阳性组患者的母亲IgG和IgM抗体阳性率分别为34．8％和17．4％，高于阴性组患者的母亲（分别为16．0％和7．3％；P〈0．01和P〈0．05）。（3）阳性组患者在兴奋、敌对、装相和作态、意志障碍、冲动控制障碍、愤怒、延迟满足困难等项目的得分均高于阴性组（P〈0．01），猜疑／被害得分低于阴性组（P〈0．01）。（4）阳性组患者病程的中位数和四分位数（P25，P75）分别为3（1，9）个月，短于阴性组患者4（2，10）个月（P〈0．05）。结论弓形虫感染在首发精神分裂症患者中占有一定的比例，且弓形虫感染阳性患者的临床表现不同于未感染者，弓形虫感染可能与精神分裂症的发病有关。     

急性缺血性脑血管病患者肺炎衣原体感染与血清C反应蛋白的关系

目的:探讨肺炎衣原体感染在急性缺血性脑血管病炎症反应中的作用。方法:检测30例急性缺血性脑血管病患者和30例正常对照者血清中肺炎衣原体特异性抗体IgG和IgM,以及血清C反应蛋白水平。结果:缺血性脑血管病患者血清C反应蛋白水平高于对照者(P<0.01)。血清肺炎衣原体IgG抗体阳性脑血管病患者血清C反应蛋白水平(0.57±0.56mg/dl)高于IgG抗体阴性脑血管病患者(0.42±0.21mg/dl)(P>0.05)。血清肺炎衣原体IgM抗体阳性脑血管病患者血清C反应蛋白水平(0.67±0.73mg/dl)高于IgM抗体阴性脑血管病患者(0.47±0.35mg/dl)(P>0.05)。结论:肺炎衣原体急性和慢性感染均参与急性缺血性脑血管病的炎症反应过程,并与其它卒中因素共同引起血清C反应蛋白水平升高。     

脑脊液髓鞘碱性蛋白抗体检测对格林-巴利综合征的临床价值

目的探讨格林-巴利综合征（GBS）中枢神经髓鞘的免疫性损伤。方法GBS患者20例，神经系统其它疾病组（OND）20例，非神经系统疾病手术者33例。以酶联免疫吸附法检测73份脑脊液（CSF）中髓鞘碱性蛋白IgG（MBP－IgG）。结果GBS患者、OND患者和非神经系统疾病手术者CSF中MBP－IgG阳性率分别为55％、30％和9.1％。GBS患者CSF中MBP-IgG阳性率与发病天数有关。结论部分GBS有中枢神经髓鞘的免疫性损害，证实GBS是自身免疫性脱髓鞘病。     

血清Cj抗体、GM1抗体和格林-巴利综合征的相关性研究

格林－巴利综合征（GBS）病因及发病机理探讨。方法采用ELISA法测定30例格林－巴利综合征（GBS）患者血清抗空肠弯曲菌抗体（Cj－Ab）及GM1抗体（GM1－Ab）,并与临床严重程度进行相关分析。结果GBS组血清Cj－IgG、IgM阳性率分别为60％、30％,较对照组30．8％和7．7％为高,两组差异有显著性,P值均小于0．05。GBS组GM1－IgG阳性率为38％,而对照组为2．1％,经检验两者差异也有显著性,P值均小于0．05。结论Cj近期感染与GBS发病相关,而GBS的两种抗体与临床严重程度无明显关系。     

间接免疫荧光法研究EB病毒感染类型与多发性硬化发生的关系

目的 用间接免疫荧光法研究EB病毒(EBV)不同感染类型与多发性硬化(MS)发生的关系.方法 采用间接免疫荧光法检测20例MS患者和20例其他神经科疾病(OND)患者脑脊液(CSF)中抗EBV壳抗原(EBV-CA)IgG抗体、抗EBV-CA IgG抗体亲和力、抗EBV-CA IgM抗体、抗EBV早期抗原(EBV-EA)...     

Chlamydia pneumoniae infection associated with enhanced MRI spinal lesions in multiple sclerosis

Cerebrospinal fluid (CSF) from 66 patients with multiple sclerosis (MS) and 25 patients with other neurological diseases (OND) were examined for the infection of Chlamydia pneumoniae by culture, polymerase chain reaction (PCR) assay, and determination of antibodies to C. pneumoniae. PCR was positive not only in 9 of 28 (32%) patients with MS but also in 2 patents with inflammatory disorders in 15 (13%) OND controls (p = 0.18). Viable C. pneumoniae was isolated from one patient with MS and one with paraneoplastic encephalomyelitis. C. pneumoniae could be detected only in cell-containing CSF. In MS, enhanced spinal magnetic resonance imaging (MRI) lesions were detected in all of four PCR-positive patents but none of five PCR-negative patients, and the difference was significant (p = 0.0079). However, no correlation was found between enhanced brain MRI lesions and CSF C. pneumoniae DNA. Elevated titers of anti-C. pneumoniae IgG were detected in CSF in 13 of 66 (20%) patients with MS and 1 of 25 (4%) OND controls (p = 0.064). CNS C. pneumoniae infection is not uncommon in MS as well as in other inflammatory disorders of the nervous system. The association of active spinal lesions with Chlamydia in CSF collected by lumber puncture suggests the detection of a recent infection. On the other hand, the lack of association of active MS brain lesions with CSF Chlamydia and the presence of PCR-positive patents who are clinically stable and have no enhancing MRI lesions imply the existence of a chronic infectious process.     

Mycoplasma pneumoniae in elderly patients with stroke. a case-control study on the seroprevalence of M. pneumoniae in elderly patients with acute cerebrovascular disease - the M-PEPS Study

BACKGROUND AND PURPOSE: Previous studies have suggested certain infections as potential risk factors for stroke. Chlamydia pneumoniae, an atypical respiratory pathogen, has been linked to atherosclerotic vascular diseases. Mycoplasma pneumoniae, another atypical respiratory micro-organism, can rarely cause stroke. We investigated whether serological markers of M. pneumoniae infection were associated with acute stroke or transient ischaemic attack (TIA) in elderly patients. METHODS: This case-control study was nested within the C-PEPS study - a case-control study on the seroprevalence of C. pneumoniae in elderly stroke and medical patients. Ninety-five incident cases of patients admitted consecutively with acute stroke or TIA, and 82 control subjects admitted concurrently with acute non-cardiopulmonary, non-infective disorders, were included in this study (both groups aged 65 years or older). Using commercial enzyme-linked immunosorbent assay (ELISA) kits, the presence of M. pneumoniae immunoglobulins IgA, IgG and IgM in patients' sera was determined. RESULTS: The seroprevalence of M. pneumoniae IgA, IgG and IgM in the stroke or TIA group (median age = 80) were 79, 61 and 6%, respectively. In the control group (median age = 80), the seroprevalence of respective M. pneumoniae IgA, IgG and IgM were 84, 50 and 11%. Using a logistic regression statistical model, adjusting for history of hypertension, smoking, diabetes mellitus, age and sex, history of ischaemic heart disease, and ischaemic electrocardiogram, the odds ratios of having a stroke or TIA in relation to M. pneumoniae IgA, IgG and IgM were 0.63 (95% confidence interval (CI) = 0.26-1.52, p = 0.31), 1.32 (95% CI = 0.66-2.64, p = 0.43) and 0.52 (95% CI = 0.14-1.92, p = 0.32), respectively. CONCLUSIONS: The study showed a high seroprevalence of M. pneumoniae in an elderly hospital population, using ELISA. Although the study ruled out M. pneumoniae seropositivity as a major risk factor for stroke in this elderly population, a smaller effect could not be excluded due to the small sample size. Future larger studies may be required to determine the precise role of M. pneumoniae infection in the pathogenesis of different subtypes of ischaemic stroke, in all age groups, and in different ethnic populations.     

Multiple sclerosis is associated with enhanced B cell responses to the ganglioside GD1a

The occurrence and role of autoantibodies to gangliosides and other lipid-containing components of the central nervous system in Multiple Sclerosis (MS) are unsettled. Using sensitive ELISAs, we measured IgG and IgM antibody titers and absorbances to the three major gangliosides GD1a, GD1b and GM1, and to sulfatides, cardiolipin and myelin proteins in paired serum and cerebrospinal fluid (CSF) from patients with untreated MS, optic neuritis (ON), acute aseptic meningo-encephalitis (AM) and other neurological diseases (OND). Twenty-three per cent of 30 MS (P<0.04) and 18% of 32 ON patients (P<0.05) presented elevated IgG antibody titers to GD1a in serum compared to 9% of patients with OND. Six (40%) of the patients with malignant MS had elevated serum IgG antibody titers to GD1a compared to one (6%) of the patients with benign MS (P<0.04). In CSF, elevated IgG antibody titers to GD1a were measured in 13% of MS and 20% of ON patients compared to 4% of patients with OND (P<0. 03 and P<0.02, respectively). The augmented IgG response to GD1a in serum also separated MS from Guillain-Barré syndrome. Compared to OND increased IgM absorbances to sulfatides and cardiolipin were observed in CSF of patients with MS, but also in AM. Elevated IgG antibody titers to myelin proteins were found more often in MS patients' serum and MS, ON and AM patients' CSF compared to OND. The data implicate that among the multitude of enhanced B-cell responses occurring in MS and ON, that directed to GD1a is common and more discriminative, and should be evaluated in future MS treatment studies.     

Serum anti-Glc(alpha1,4)Glc(alpha) antibodies as a biomarker for relapsing-remitting multiple sclerosis

There is an unmet need to develop specific biomarkers for multiple sclerosis (MS) to aid in the diagnosis, improve the management of patients and the monitoring of the effectiveness of treatment. We have screened serum from patients with relapsing-remitting MS (RRMS, n = 107) against a library of glycans on a glycan chip, and have found significantly higher levels of IgM anti-Glc(alpha1,4)Glc(alpha) antibodies (anti-Galpha4Galpha antibodies) than in patients suffering from other neurological diseases (OND, n = 50, p < 0.0001), and other autoimmune diseases (OAD, n = 27, p = 0.02). No significant differences were found relative to patients having primary progressive MS (n = 16). No significant differences were detected between the levels of IgM anti-Galpha4Galpha antibodies in sera from patients with RRMS in relapsing versus remitting state, and in patients treated with immunotherapy versus untreated patients. To test whether the highly significant difference in the levels of IgM anti-Galpha4Galpha between RRMS and OND group is due to general increase in IgM levels, we have measured total serum IgM in a subgroup of 62 MS and 48 OND patients. Although the total IgM was significantly lower in the OND than the RRMS group (p = 0.0007), analysis of covariance (ANCOVA) reveled no statistically significant relationship to the covariate (total IgM). Furthermore, following normalizing the values to total IgM the difference in the levels of IgM anti-Galpha4Galpha between the MS and OND groups was found highly significant (p < < 0.0001). The present findings support further assessment of serum anti-Galpha4Galpha antibodies as a potential biomarker for MS, which may confirm disease diagnosis and aid in its management.     

Chlamydia pneumoniae-specific serum immune complexes in patients with multiple sclerosis

The significance of Chlamydia pneumoniae infection in patients with multiple sclerosis (MS) is unclear. We determined the frequency of serum C. pneumoniae-specific immune complexes in patients with MS, neurological (OND) and healthy controls in a blinded, cross-sectional study. C. pneumoniae immune complexes were detected in 24% (38/156) of MS patients, 16% (11/69) of OND and 15% (77/499) of healthy controls. The odds ratio for all MS patients was 3.95 (95% CI: 2.15 to 7.24; P < 0.0001) accounting for the covariates: sex, age, socio-economic status and area of residence. The odds ratio for recently diagnosed MS patients was 4.33 (95% CI: 1.76 to 10.64; P = 0.001). Systemic C. pneumoniae infection is more frequent in MS patients than the healthy population and occurs early in the course of the disease.     

Presence of Chlamydia pneumoniae DNA in the cerebral spinal fluid is a common phenomenon in a variety of neurological diseases and not restricted to multiple sclerosis

Chlamydial DNA and viable organisms have been reported in the cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients. We investigated whether this phenomenon is specific for MS and not occurring in patients with other neurological diseases (OND) or in healthy controls and whether it is caused by infected blood monocytes having crossed the blood-brain barrier. Twelve (21%) of fifty-eight MS patients and 20 (43%) of 47 OND patients had Chlamydia pneumoniae DNA in the CSF as determined by nested polymerase chain reaction. Viable organisms were cultured from one OND patient. We failed to detect C. pneumoniae in the CSF of 67 neurologically healthy persons. C. pneumoniae was detected in parallel in the blood monocytes of 2 of 6 CSF-positive MS patients and in 8 of 10 CSF-positive OND patients. Thus, chlamydial presence cannot exclusively be explained as being caused by contaminating infected monocytes that have crossed the blood-brain barrier. In peripheral blood mononuclear cell-negative patients, chlamydia have been cleared from the circulation but persist in the central nervous system (CNS), indicating the establishment of a chronic process. In summary, the presence of C. pneumoniae in patients with neurological diseases is a common phenomenon and is not restricted to MS patients. The pathogenetic relevance of a chronic chlamydial CNS infection for neurological diseases remains unclear, but the hypothesis that susceptible patients may be impaired in their ability to clear chlamydiae from the CNS requires further examination.     

Elevated levels of anti-Chlamydia pneumoniae IgA and IgG antibodies in young adults with ischemic stroke

INTRODUCTION: Data on the role of Chlamydia pneumoniae in patients with ischemic stroke are inconsistent. We investigated the presence of anti-C. pneumoniae antibodies in young adults with ischemic stroke. METHODS: 94 patients (<55 years) with ischemic stroke and 103 controls were enrolled. Indices of anti-C. pneumoniae IgA and IgG were assessed with an ELISA. We determined OR and 95% CI for the IgA and IgG seropositivity in stroke cases. RESULTS: Mean IgA and IgG indices were higher in stroke patients vs controls (IgA: 1.40 vs 0.56; P < 0.001; IgG: 0.85 vs. 0.78; P < 0.003). The IgA seropositivity was associated with stroke risk (11.92; 5.94-23.92; P < 0.001) as well as IgG seropositivity was (2.31; 1.15-4.61; P < 0.016). Seropositivity assessed with combined IgA and IgG indices was associated with increased stroke risk (OR 9.35; 95% CI 4.78-18.29; P < 0.0001). After controlling for age and sex, the IgA seropositivity yielded a significantly adjusted OR for stroke (8.95; 4.44-18.07; P < 0.002), while IgG seropositivity did not (0.85; 0.53-1.63). CONCLUSIONS: We find an increased risk of stroke in young patients seropositive to C. pneumoniae in the IgA antibody class. Further studies to explore this finding are warranted.     

多发性硬化患者血清和脑脊液Epstein-Barr病毒抗体检测的意义

目的探讨多发性硬化(MS)患者血清和脑脊液(CSF)中EpsteinBarr(EB)病毒IgG抗体检测的意义。方法采用酶联免疫吸附法检测MS患者65例、其他神经科疾病(OND组)患者71例、非神经科疾病(NND组)患者42例的血清和CSF中EB病毒核抗原、壳抗原和早期抗原的IgG抗体,并进行分析比较。根据血清抗体检测结果的组合,分析各组中病毒初次感染、既往感染和病毒重新激活的情况。结果3组患者血清EB病毒核抗原、壳抗原IgG抗体阳性率均>90%,差异无显著性(均P>0.05)。MS组EB病毒早期抗原IgG抗体阳性率(46.2%)明显高于其他两组(18.3%,9.5%,均P<0.05)。MS组病毒感染重新激活的比率(46.2%)明显高于其他两组(18.3%,9.5%,均P<0.05)。3组CSF病毒抗体阳性率差异无显著性(均P>0.05)。结论MS患者活动性的EB病毒感染较多,EB病毒感染重新激活的比例很高。     

IgG index in acute idiopathic peripheral facial palsy

OBJECTIVES: Etiologic hypotheses in acute idiopathic peripheral facial palsy (AIPFP) mostly point to an immunologic dysfunction, probably virus-induced. Though various immunologic abnormalities are reported, the problem is still unsolved. We investigated intrathecal immunoglobulin synthesis in AIPFP as a clue for central nervous system (CNS) immunopathology. MATERIAL AND METHODS: We studied IgG index in 24 patients with AIPFP, 10 with other neurological diseases (OND) and 17 with multiple sclerosis (MS). CSF and serum IgG were measured by radial immunodiffusion technique. IgG index is calculated according to Tibbling's formula. RESULTS: IgG indexes were abnormal in 6 patients with AIPFP, 3 with OND and 10 with MS patients. There was no statistical difference between AIPFP and OND groups, while marked difference existed between AIPFP and MS groups. CONCLUSION: Though IgG indexes were high in 25% of AIPFP patients, statistical analyses did not show any significance of this finding. Lack of a positive result might reflect non-existence of an extensive immunologic pathology within CNS, excluding a very limited one.