疱液在诊断表皮下自身免疫性大疱病中的意义

目的：探讨表皮下自身免疫性大疱病疱液中抗基底膜带（ＢＭＺ）自身抗体的情况及在诊断中的意义。方法：应用非盐裂皮肤及盐裂皮肤间接免疫荧光技术（ＩＦ）检测３８例表皮下自身免疫性大疱病患者疱液和血清中ＩｇＧ、ＩｇＡ、ＩｇＭ、ＩｇＥ及ＩｇＧ亚型ＩｇＧ１～ＩｇＧ４抗ＢＭＺ抗体及滴度，并检测疱液和血清中结合补体Ｃ３的特异性抗ＢＭＺ抗体。结果：（１）疱液和血清中抗ＢＭＺ抗体及滴度和结合补体Ｃ３的特异性抗ＢＭＺ抗体均无显著性差异。（２）大疱性类天疱疮患者的疱液和血清中ＩｇＧ抗ＢＭＺ抗体的亚型分布相同，主要为ＩｇＧ１和ＩｇＧ４。结论：疱液可作为ＩＩＦ检测表皮下大疱病抗ＢＭＺ抗体的另一个有价值的标本来源。     

性病门诊就诊者沙眼衣原体60KD抗体的检测

目的了解泌尿生殖道沙眼衣原体感染者针对衣原体不同抗原成分的血清学反应。方法应用沙眼衣原体细胞培养、免疫印迹试验和微量免疫荧光试验（ＭＩＦ）,对３００例性病门诊就诊者进行观察。结果沙眼衣原体培养阳性者７５例,其中６２例（８２．６％）出现６０ＫＤ抗体,培养阴性者２２５例,其中７６例（３３．８％）（Ｐ＜０．０１）出现该抗体。然而,培养阴性又出现６０ＫＤ抗体者正是ＭＩＦ阳性者。９６．６７％的就诊者主要外膜蛋白（ＭＯＭＰ）抗体阳性。结论检测沙眼衣原体６０ＫＤ抗体在某些人群中可能具有血清学辅助诊断价值。     

生殖道沙眼衣原体细胞培养和血清学研究

目的 研究孕妇、盆腔炎患者和ＳＴＤ门诊男女就诊者生殖道沙眼衣原休病原学、血清学及两者之间的关系，并与对照人群进行比较。方法 细胞培养检测生殖道沙眼衣原体；酶免疫和微量免疫荧光试验方法检测血清沙眼衣原体抗体。结果 孕妇、盆腔炎患者和ＳＴＤ男女就诊者生殖道沙眼衣原体阳性率分别为３．３％，６．７％，２０．４％和１５．６％；血清沙眼衣原本酶免疫法检测ＩｇＧ／微量免疫荧光试验方法ＩｇＧ抗体阳性率分别４６．７     

花斑癣患者血清中抗糠秕马拉色菌IgG、IgM、IgA抗体的检测及其意义

目的：探讨机体体液免疫在花斑癣发病中的作用和意义。方法：以糠秕马拉色菌（Ｍ．ｆｕｒｆｕｒ）整菌（ＷＭＦ）为抗原,用间接酶联免疫吸附试验（ＥＬＩＳＡ）方法,检测６８例花斑癣患者和４１例正常人血清中的抗ＷＭＦ抗体。结果：正常人血清中存在高滴度的抗ＷＭＦ抗体,花斑癣患者血清中抗ＷＭＦＩｇＧ抗体明显低于正常对照组（Ｐ〈０．０１）,男性患者血清中ＩｇＧ抗体低于女性患者（Ｐ〈０．０１）,病程１年以上者血清中特异的ＩｇＧ抗体低于病程不到１年者（Ｐ〈０．０１）。结论：机体血清抗Ｍ．ｆｕｒｆｕｒ抗体可能是人体内天然抗体,且特异的ＩｇＧ抗体具有保护作用。支持花斑癣的发病与免疫缺陷有关。     

沙眼衣原体热休克蛋白60抗体的测定

为了了解泌尿生殖道沙眼衣原体感染者对沙眼衣原体热休克蛋白６０（ＨＳＰ６０）的血清学反应，应用细胞培养、免疫印迹试验和微量免疫荧光试验（ＭＩＦ）对１７５例非淋菌性尿道炎（宫颈炎）（ＮＧＵ）、７３例盆腔炎（ＰＩＤ）、５２例不育症及３６例健康对照者进行检查。３组患者的沙眼衣原体感染率有显著差异（Ｐ＜０．０１）。１７．８％的ＰＩＤ、１３．５％的不育症和１．７％的ＮＧＵ患者出现ＨＳＰ６０抗体，而健康对照组则未检出此抗体（Ｐ＜０．０１）。ＭＩＦ高滴度者（≥１∶１６０）出现ＨＳＰ６０抗体的机率（３１．３％）明显高于低滴度者（＜１∶１６０）（２．８％）（Ｐ＜０．０１）。提示在有并发症的患者中ＨＳＰ６０抗体常见。检测ＨＳＰ６０抗体对预测沙眼衣原体感染慢性发展及并发症的发生有一定意义。     

自身免疫性表皮下大疱病基底膜带自身抗体的检测

目的 比较免疫印迹（ＩＢ）和盐裂皮肤间接免疫荧光（ＩＩＦ）检测自身免疫性表皮下大疱病（ＳＡＢＤ）基底膜带自身抗体（ＢＭＺ－Ａｂ）的敏感性和特异怀。方法 分另应用ＩＩＦ和ＩＢ技术对９７例ＳＡＢＤ患者血清中ＩｇＧ型或ＩｇＡ型ＢＭＺ－Ｚｂ进行检测。结果 ＩＩＦ法阳性率７５．３％,免疫印迹法阳性率７９．４％,两者在检测灵敏度上无显著性差异。结论 二者均可用于ＳＡＢＤ中ＢＭＺ－Ａｂ的检测,二者联用对于提高Ｂ     

非淋菌性尿道炎的衣原体检测和支原体培养

对１５８例（男６４例，女９４例）非淋菌性尿道炎（ＮＧＵ），用直接免疫荧光法检测分泌物中沙眼衣原体；用培养法检测分泌物中解脲支原体。结果衣原体阳性５３例（３３．５４％）；支原体阳性３２例（２０．２５％）。对２８例淋病检出衣原体阳性３例，支原体阳性３例，共占淋病组２１．４２％。健康对照组４０例，只一例检出衣原体（２．５％），与ＮＧＵ组比较，有非常显著性差异（Ｐ＜０．０１）。     

临床标本中沙眼衣原体噬菌体Vp1基因及血清Vp1抗体的检测

目的 检测临床标本中沙眼衣原体噬菌体Vp1基因及血清Vp1抗体.方法 收集天津性传播疾病研究所就诊患者的分泌物拭子和血清;用PCR法筛查分泌物标本中的Vp1基因;以Vp1蛋白作为抗原通过ELISA法及Western印迹法检测血清中针对Vp1抗体的存在;对PCR法结果阳性的分泌物进行细胞培养,然后免疫荧光法进行检测Vp1.结果 共筛查出36例拭子的PCR扩增产物在目的片段位置出现明显条带,及23例Vp1抗体阳性的血清.通过细胞培养及免疫荧光法,利用制备的单抗检测沙眼衣原体临床标本,尚未发现阳性标本.结论 从临床拭子及血清中成功筛查出沙眼衣原体噬菌体Vp1基因和Vp1抗体.     

不同血清型沙眼衣原体小鼠生殖道感染模型的建立

目的 建立不同血清型沙眼衣原体小鼠生殖道感染模型,为研究型别与毒力的关系奠定基础。方法 将6周龄BALB/c雌性小鼠分为4组,实验组经孕酮处理后接种4.0 × 107沙眼衣原体,孕酮对照组接种McCoy细胞培养液,无孕酮对照组直接接种4.0 × 107沙眼衣原体,以及单纯小鼠的空白对照。分别于接种后4 d起观察小鼠外阴变化,阴道分泌物细胞培养、直接免疫荧光法和实时荧光PCR检测沙眼衣原体。结果 实验组接种沙眼衣原体E、F、J和K型,4 d后小鼠生殖道表现出轻微的感染迹象,7 d后阴道分泌物培养、免疫荧光和PCR检测均检出沙眼衣原体,而对照组为阴性。感染持续时间以K型最长（21 d,1/11只阳性）,其次为J型（17 d,1/11只阳性）、F型（14 d,5/11只阳性）和E型（14 d,2/11只阳性）。结论 适龄小鼠经孕酮处理后,接种一定量的沙眼衣原体,可建立不同血清型沙眼衣原体感染模型。     

2825例皮肤病患者皮损直接免疫荧光检查结果分析

目的为了探讨直接免疫荧光检查对某些皮肤病的意义。方法采用抗人Ｉｇ（ＩｇＧ、ＩｇＡ、ＩｇＭ和补体Ｃ３）直接免疫荧光技术对２８２５例（８９个病种）皮肤病患者皮损作了检查。结果９２６例系统性红斑狼疮皮损区基底膜阳性占９５％,曝光区正常皮肤基底膜阳性占８０％,而２８７例盘状红斑狼疮皮损基底膜阳性占９２％,曝光区正常皮肤均阴性;６２例混合结缔组织病皮损区阳性为８５％;１８４例皮肌炎皮损血管壁阳性７０％;７３例系统性硬皮病皮损区阳性７０％;２１１例寻常型银屑病皮损区角质层阳性９３％;１２５例寻常性天疱疮皮损区表皮细胞间阳性９５％;８５例大疱性类天疱疮的阳性为９２％;７１例疱疹样皮炎的阳性为９０％;１１６例血管炎病灶区血管壁阳性为９０％。结论提示ＳＬＥ、ＤＬＥ及大疱性皮肤病皮损的免疫荧光标记形态具有特征性改变。而且,直接免疫荧光检查对其它皮肤病的诊断与鉴别诊断也有重要意义。     

Interpretation of Chlamydia trachomatis antibody response in chlamydial oculogenital infection.

OBJECTIVE--To study: (a) the chlamydial antibody response (to the D-K serovars) using the micro-immunofluorescence (micro-IF) test in the following groups: (I) chlamydial genital infection only, (II) chlamydial ocular infection only, (III) combined chlamydial ocular and genital infection (oculo-genital infection), (IV) chlamydial ocular infection with chlamydia-negative non-gonococcal urethritis, (V) adenovirus conjunctivitis (control group 1), (VI) male partners of group I-IV with no chlamydial oculogenital infection or non-gonococcal urethritis (control group 2) (b) the cross reactivity of antibodies in patients' sera between the three chlamydial species and within the serovars of C trachomatis in those with culture-positive chlamydial oculo-genital infection. SETTING--oculogenital (diagnostic) clinic at Moorfields Eye Hospital, London, UK. SUBJECTS--209 consecutive patients attending the clinic with Chlamydia trachomatis oculogenital infection and 86 patients with adenovirus conjunctivitis (control group 1) and 55 male partners with no evidence of chlamydial oculogenital infection or non-gonococcal urethritis (control group 2). RESULTS--Of all the patients with proven chlamydial oculogenital infection, 10.5% (22/209) and 94% (197/209) had IgM and IgG antibodies respectively. The geometric mean IgG antibody titres (GMT) were 1:98, 1:123, 1:245 and 1:101 in groups I to IV respectively. The IgG GMT values seen in control groups 1 and 2 were 1:45 and 1:36 respectively. Only 2/86(2%) patients in group V (control group 1) had IgG chlamydial antibodies of 1:32 and 1:64, whilst only 1/55(1.8%) and 4/55(7.3%) of patients in group VI(control group 2) had chlamydial IgG antibody titres of > or = 1:256 and > or = 1:128 respectively. A four-fold rise or fall in IgG antibody titre occurred in 56%(107/192) of patient groups I-IV over 2-6 weeks. Low titre cross-reactive antibody responses against different chlamydial species and serovars were commonly seen; 71%(148/209) of all patients showed cross-reactivity with Chlamydia pneumoniae or psittaci species or both, whilst 92% (193/209) of patients showed some level of cross reactivity to other pooled serovars of C trachomatis (A-C and L 1-3). CONCLUSIONS--Serological diagnosis of chlamydial infection as evidenced by a positive IgM antibody response, high IgG titre (> or = 1:256) or > or = 4-fold rise or fall in IgG antibody titre was seen in 78%(163/209) of patients with culture-positive chlamydial oculogenital infection. Chlamydial IgG antibody titres of > or = 1:256 had a sensitivity of 42.6%, specificity of 98.2%, positive predictive value of 98.8% and a negative predictive value of 31% for chlamydial infection at any site, when considering groups I-IV and control group 2. In this study of 216 patients with conjunctivitis, a positive IgG antibody response (titre > or = 1:16) had a sensitivity of 98.5%, specificity of 97.7%, positive predictive value of 98.5% and a negative predictive value of 97.7%, for chlamydial conjunctivitis. Patients with dual chlamydial infection of conjunctiva and genital tract had a higher IgG GMT titre than those with ocular or genital infection alone: infection at a second site may produce an anamnestic response. Although the micro-IF test is a useful adjunct for the diagnosis of chlamydial infection, cross-reactivity between different chlamydial species and serovars is common. Chlamydial seroepidemiological studies should be interpreted with caution, as studies may attribute a serological response to a particular species or serovar in a setting where two or more are prevalent.     

Antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae in sera from patients with acute salpingitis.

Paired sera from 60 consecutive patients with acute salpingitis, confirmed by laparoscopy, were examined for serum antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae. By a microimmunofluorescence (MIF) test IgM or IgG antibodies to C trachomatis or both were present in sera from 80% of the patients' by indirect haemagglutination (IHA) tests antibodies to M hominis and N gonorrhoeae pilar antigens were present in 40% and 18% respectively. In a control group of 50 pregnant women antibodies to the same three organisms occurred in 8%, 8%, and 6%. Evidence of current chlamydial infection was found in 35 (58%) and of current gonococcal infection in five (8%) of the 60 patients by culture or serological tests or both. The results of chlamydial antibody tests correlated with the severity of the tubal inflammation (as shown by laparoscopy) and the duration of the lower abdominal pain before attendance. The predictive values of a positive and a negative MIF test result were 44% and 83% respectively and of the IHA gonococcal antibody test 36% and 100% respectively. Significant rises in titre of antibodies to M hominis were found in 12% of patients. A four-fold or greater rise in titre indicated probable double infections with chlamydia and mycoplasmas in 7% of patients. Thus, at present gonococcal salpingitis appears to form only a small proportion of all cases of salpingitis in southern Sweden, and in patients with nongonococcal salpingitis infections with C trachomatis and M hominis commonly occur.     

Antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae in sera from patients with acute salpingitis

Paired sera from 60 consecutive patients with acute salpingitis, confirmed by laparoscopy, were examined for serum antibodies to Chlamydia trachomatis, Mycoplasma hominis, and Neisseria gonorrhoeae. By a microimmunofluorescence (MIF) test IgM or IgG antibodies to C trachomatis or both were present in sera from 80% of the patients' by indirect haemagglutination (IHA) tests antibodies to M hominis and N gonorrhoeae pilar antigens were present in 40% and 18% respectively. In a control group of 50 pregnant women antibodies to the same three organisms occurred in 8%, 8%, and 6%. Evidence of current chlamydial infection was found in 35 (58%) and of current gonococcal infection in five (8%) of the 60 patients by culture or serological tests or both. The results of chlamydial antibody tests correlated with the severity of the tubal inflammation (as shown by laparoscopy) and the duration of the lower abdominal pain before attendance. The predictive values of a positive and a negative MIF test result were 44% and 83% respectively and of the IHA gonococcal antibody test 36% and 100% respectively. Significant rises in titre of antibodies to M hominis were found in 12% of patients. A four-fold or greater rise in titre indicated probable double infections with chlamydia and mycoplasmas in 7% of patients. Thus, at present gonococcal salpingitis appears to form only a small proportion of all cases of salpingitis in southern Sweden, and in patients with nongonococcal salpingitis infections with C trachomatis and M hominis commonly occur.     

Antichlamydial antibodies in pelvic inflammatory disease.

The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.     

Comparison of the Amplicor Chlamydia trachomatis test and cell culture for the detection of urogenital chlamydial infections.

OBJECTIVE--To compare the polymerase chain reaction (PCR) Amplicor Chlamydia trachomatis test with the cell culture method, in diagnosing urogenital chlamydial infections. SUBJECTS--439 patients (327 women and 112 men) attending one STD clinic and Family Planning and Gynaecological Clinics in Lisbon, Portugal, between November 1993 and March 1994. METHODS--In women, two endocervical swab samples were collected: one for PCR Amplicor and one for standard culture technique. Men were asked to submit 20 ml of urine (first pass urine) for PCR Amplicor and one urethral specimen was taken for culture. The order of collection of the specimens was rotated every 50 patients. Discrepant results were further analysed by a second PCR with primers directed against the C trachomatis major outer membrane protein (MOMP) and by direct fluorescent antibody (DFA). RESULTS--After analysis of discrepancies, the adjusted sensitivity and specificity of PCR on endocervical specimens were 92.9% and 100% and the positive and negative predictive values were 100% and 99.7% respectively; on the urine samples these values were 100%, 99.1%, 100% and 99.1%, respectively. CONCLUSION--These results indicate that the PCR Amplicor test is a rapid sensitive and specific assay for the detection of C trachomatis in urogenital infections and provides a non-invasive technique for screening chlamydia infection in men.     

Antichlamydial antibodies in pelvic inflammatory disease

The role of Chlamydia trachomatis in pelvic inflammatory disease (PID) diagnosed without laparoscopy was assessed by measuring antichlamydial antibodies in the patient's serum and by comparing the results with those in patients with uncomplicated non-specific genital infection (NSGI) and gonorrhoea and in non-infected controls. A modified microimmunofluorescence test was used. Patients with severe PID had significantly more positive antichlamydial IgG and IgM results than did control subjects, patients with gonorrhoea, and patients with NSGI. Less severe PID was associated with significantly raised levels of antichlamydial IgG antibodies compared with NSGI and controls and with raised levels of IgM antibodies compared with controls. Two patients with PID had lower genital tract gonorrhoea, one of whom had raised antichlamydial antibody levels. These findings may indicate a mixed infection and therapy should be reviewed in such patients. A serological diagnosis of chlamydial infection is relatively easy and cheap and enables a rapid diagnosis of chlamydial infection to be made.     

Rapid diagnosis of chlamydial infection of the cervix.

A rapid serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix has been developed. The method used in based on the modified micro-immunofluorescence test using pooled chlamydial antigens and the detection of different immunoglobulin classes of chlamydial antibody in sera and cervical secretions. The presence of IgG chlamydial antibody at a level of 1/64, or IgM antibody at a level of 1/8 or greater, or both in sera and IgG or IgA antibody at a level of 1/8 or more or both in cervical secretions was closely associated with the isolation of Chlamydia trachomatis and non-specific genital infection. In general, serodiagnosis was three to nine times more sensitive than cultural methods, and the detection of IgG chlamydial antibody in cervical secretions alone provided the most sensitive of the serological tests. This sensitive, low-cost, rapid, and simple serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix, coupled with transportation of specimens by post, offers advantages over conventional isolation techniques for the routine diagnosis and management of chlamydial genital infections.     

Rapid diagnosis of chlamydial infection of the cervix.

A rapid serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix has been developed. The method used in based on the modified micro-immunofluorescence test using pooled chlamydial antigens and the detection of different immunoglobulin classes of chlamydial antibody in sera and cervical secretions. The presence of IgG chlamydial antibody at a level of 1/64, or IgM antibody at a level of 1/8 or greater, or both in sera and IgG or IgA antibody at a level of 1/8 or more or both in cervical secretions was closely associated with the isolation of Chlamydia trachomatis and non-specific genital infection. In general, serodiagnosis was three to nine times more sensitive than cultural methods, and the detection of IgG chlamydial antibody in cervical secretions alone provided the most sensitive of the serological tests. This sensitive, low-cost, rapid, and simple serodiagnostic test for the presumptive diagnosis of chlamydial infection of the cervix, coupled with transportation of specimens by post, offers advantages over conventional isolation techniques for the routine diagnosis and management of chlamydial genital infections.     

泌尿生殖道沙眼衣原体感染者血清抗衣原体免疫优势蛋白抗体的检测

【摘要】 目的 检测泌尿生殖道沙眼衣原体感染者血清中的抗衣原体质粒编码蛋白3（Pgp3）、抗外膜蛋白复合物B蛋白C端肽（OmcBc）、抗ct841编码蛋白（CT841）和抗热休克蛋白60（HSP60）抗体。 方法 将编码上述4种蛋白基因的重组质粒和空质粒转化入大肠杆菌,IPTG诱导表达,并用谷胱甘肽磁珠进行纯化后包被ELISA孔板。收集天津医科大学总医院性病门诊泌尿生殖道沙眼衣原体感染者和未感染者血清各20份。ELISA法检测血清中上述蛋白抗体。 结果 20份沙眼衣原体感染者血清中Pgp3、OmcBc、CT841和HSP60抗体的检出率分别是14例（70%）、9例（45%）、8例（40%）、5例（25%）;20份无沙眼衣原体感染者血清中,仅1例检测到HSP60抗体。 结论 上述4种衣原体蛋白中,Pgp3的抗原性最强,抗体检出率最高;HSP60的抗原性最弱,抗体检出率最低。 【关键词】 衣原体,沙眼; 监控蛋白60; Pgp3; OmcB; CT841     

Chlamydial cervicitis and urethritis: single dose treatment compared with doxycycline for seven days in community based practises.

STUDY GOAL: To compare the efficacy and safety of single 1 g oral azithromycin with doxycycline, 100 mg twice daily for seven days for treatment of uncomplicated urogenital chlamydial infection. STUDY DESIGN: Randomised, unblinded, comparative trial, involving 597 patients demonstrating clinical evidence of genital chlamydia and a positive non-culture assay for Chlamydia trachomatis. RESULTS: Among the azithromycin- and doxycycline-treated patients 61% and 60%, respectively, were asymptomatic within one week after the first dose. At two weeks, these figures increased to 86% and 83%, respectively. Bacteriological eradication, based on a negative assay, occurred in 338 (97%) of 347 azithromycin-treated patients and 161 (99%) of 163 doxycycline-treated patients. CONCLUSION: Treatment of uncomplicated chlamydial cervicitis and urethritis with single 1 g oral azithromycin is equivalent to standard therapy with doxycycline. Drug-related adverse events were approximately twice as common as previously reported for both drugs.