SYNOVIAL FLUID AND SERUM ANTIBODIES AGAINST CHLAMYDIA IN DIFFERENT FORMS OF ARTHRITIS: INTRA-ARTICULAR IgA PRODUCTION IN CHLAMYDIA SEXUALLY ACQUIRED REACTIVE ARTHRITIS

Since the presence of Chlamydia has been shown in synovial fluid(SF) from some patients with Chlamydia reactive arthritis, weinvestigated whether anti-Chlamydia antibodies present in thejoint are derived from the circulation or are locally produced.We compared titres of IgG, IgM and IgA antibodies against Chlamydia,and against a control antigen (tetanus toxoid), by an enzyme-linkedimmunosorbent assay (ELISA), in paired samples of serum andSF from Chlamydia trachomatis sexually acquired reactive arthritis(CT-SARA) patients and from patients with other forms of arthritis.The ratio of serum/SF IgA anti-Chlamydia antibodies was significantlydecreased in CT-SARA patients. It is concluded that, in ourexperimental conditions, we found evidence for intra-articularproduction of IgA anti-Chlamydia antibodies. KEY WORDS: Chlamydia antibodies, Synovial fluid, Enzyme-linked immunoassay     

THE HUMORAL IMMUNE RESPONSE TO CHLAMYDIA TRACHOMATIS IN PATIENTS WITH ACUTE REACTIVE ARTHRITIS

Sera from 25 patients with clinical signs of reactive arthritiswere analysed for antibodies against Chlamydia trachomatis byimmunoblotting. Purified elementary bodies, purified Chlamydiaouter membrane complexes, and purified recombinant subcomponentswere used as antigens. Antibodies against C. trachomatis cysteinerich outer membrane protein 2 (Omp2) and lipopolysaccharide(LPS) were detected in 10 patients. Thus 40% of the patientspresented antibodies specific for C.trachomatis. There was nocorrelation between acute reactive arthritis and antibodiesto heat-shock proteins GroEL, GroES and DnaK. KEY WORDS: Chlamydia trachomatis, DnaK, GroEL, Omp2, Lipopolysaccharide, Humoral immune response     

抗类风湿关节炎36kD和33kD抗体对类风湿关节炎诊断意义的研究

我们自艾氏小鼠腹水癌细胞（Ｅｈｒｌｉｃｈａｓｃｉｔｅｃｅｌｌｓ）提取抗原，进行免疫印迹法检测，发现８８例类风湿关节炎（ＲＡ）患者中有２８例抗３６ｋＤ（分子量为３６０００）抗体阳性，占３１．８％．而在１００例其他结缔组织病患者及４０例正常对照组中均无１例出现阳性。然而，用上述方法提取的抗原，以免疫印迹法检测时，抗ＲＡ３３ｋＤ抗体或抗ＲＮＰ抗体均可与３３ｋＤ区带反应，说明抗３３ｋＤ抗体对诊断ＲＡ的特异性不高。结果表明抗３６ｋＤ抗体是ＲＡ的特异性抗体。如果同时出现抗３６ｋＤ及抗３３ｋＤ抗体，则更加有利于诊断。     

SALMONELLA REACTIVE ARTHRITIS: SERUM AND SECRETORY ANTIBODIES IN EIGHT PATIENTS IDENTIFIED AFTER A LARGE OUTBREAK

Serial measurements of serum and secretory antibodies to Salmonellatyphimurium were made by ELISA in eight patients with suspectedreactive arthritis identified after a large outbreak of Salmonellagastroenteritis. All three patients from whom Salmonella hadbeen isolated developed significant serum IgG, IgA and IgM antibodyresponses. Only one of the three possessed HLA-B27. A furtherthree patients, two with HLA-B27, had raised antibodies, althoughnone had experienced gastroenteritis. Salmonella infection wasnot confirmed in the remaining two patients. The three B27-negativepatients with confirmed reactive arthritis had HLA-B locus antigenswhich serologically cross-react with B27. One of six patientswith confirmed reactive arthritis was under the age of 25 yearswhereas 256 of 418 (61%) patients with uncomplicated enteritiswere under this age. The development of reactive arthritis mayfollow subclinical Salmonella infection and is influenced bygenetic and age-related factors. KEY WORDS: Arthritis, Salmonella, Antibodies     

马来丝虫虫体抗原检测长爪沙鼠血清抗体

长爪沙鼠实验感染马来丝虫后,用感染期幼虫、微丝蚴的超声粉碎片段抗原和成虫的冰冻切片抗原,进行间接荧光抗体试验,观察血清抗体动态变化。抗感染期幼虫抗体多于感染后前3Wk内出现,抗成虫及微丝蚴抗体多于感染后前5、6wk内出现。在微丝蚴出现前,腹腔微丝蚴阳性和阴性沙鼠抗体水平差别无显著性,而在微丝蚴出现后,抗体水平具有显著性差别。     

THE PREVALENCE OF SERUM IgG ANTIBODIES TO TYPE II COLLAGEN IN AMERICAN PATIENTS WITH RHEUMATOID ARTHRITIS

Serum IgG antibody levels to native and denatured bovine typeII collagen were elevated in 31.5 and 21.5% sera respectivelyfrom 200 American patients with RA. The prevalence of serumantibodies to native type II collagen is significantly higherthan previously found in large studies of the prevalence ofthis autoantibody in Britain and Japan when using the same methodology. KEY WORDS: Collagen, Type II, Antibodies     

骨代谢指标测定在骨质疏松诊治中的应用价值

目的 比较妇女绝经前后骨代谢指标的变化，研究各指标在骨质疏松症治疗后的变化率，对各指标在骨质疏松症诊治中的应用作出初步评价。方法 48例绝经前妇女、48例绝经后妇女测定10项骨代谢指标．45例绝经后骨质疏松症患者．治疗前、治疗6个月后分别测定10项骨代谢指标，观察其变化率。12名绝经后妇女，每两个月测定10项骨代谢指标。共观察一年。结果 绝经后妇女骨代谢指标明显升高，绝经后骨质疏松症患者经抗吸收治疗后．大部分骨代谢指标明显降低，血清骨形成指标比尿骨吸收指标长期个体内的变异要小。结论 绝经后骨质疏松症患者骨转换加快，部分血清骨代谢指标优于尿骨代谢指标，尤以血清骨形成指标N—mid骨钙素和血清骨吸收指标CTX为优。     

A SEARCH FOR CHLAMYDIA TRACHOMATIS IN SYNOVIAL FLUIDS FROM PATIENTS WITH REACTIVE ARTHRITIS USING THE POLYMERASE CHAIN REACTION AND ANTIGEN DETECTION METHODS

A polymerase chain reaction (PCR) technique to detect Chlamydiatrachomatis DNA was used to examine synovial specimens frompatients with reactive arthritis. We were able to detect C.trachomatis DNA in synovial specimens which had been seededwith intact elementary bodies or chlamydial DNA. However, wewere unable to detect chlamydial DNA in unseeded synovial specimensfrom 10 patients with sexually acquired reactive arthritis,17 patients with reactive arthritis and 11 control patientswith other arthropathies. In addition, using a monoclonal antibodytechnique, we were unable to detect chlamydial antigen in anyof the synovial cell deposits examined. We conclude that C.trachomatis DNA was not present in the joints of these patientsat the time of synovial fluid collection, and suggest that eitherDNA degradation occurred rapidly after viable chlamydiae hadentered the joint or that chlamydial DNA was not present atany stage of the reactive response. KEY WORDS: Joint disease, Sexually acquired reactive arthritis, Oligoarthritis, DNA hybridization     

血清天门冬氨酸转氨酶(线粒体型)对急性心肌梗塞的诊断价值

本文报道42例急性心肌梗塞(AMI)患者血清线粒体天门冬氨酸转氨酶(m-AST)活力的动态变化。多数AMI患者血清m-AST活力在发病后12h明显升高,24h全部升高并达峰值。m-AST诊断AMI的敏感性为100%。特异性为93.5%,与CK-MB相似(P>0.20),可作为AMI诊断的酶学指标。本文未证实m-AST对AMI有预后评估价值。     

HLA-DR_4基因检测在类风湿关节炎诊治中的意义探讨

为了研究HLA-DR_4基因检测在类风湿关节炎诊治中的意义,对50例类风湿关节炎患者进行了HLA-DR_4的(PCR-SSP方法)检测,同时结合患者的临床表现和实验室指标进行分析。结果显示:HLA-DR_4阳性者31例(阳性率为62％);比较HLA-DR_4阳性和阴性两组患者其他指标,可见,HLA-DR_4阳性组的关节疼痛指数、ESR、类风湿因子(RF)滴度均明显高于HLA-DR_4阴性组(P值分别<0.05或0.01),手腕部X线在Ⅱ级～Ⅲ级异常变化者也以HLA-DR_4阳性组较多(P<0.005)。结果提示:HLA-DR_4基因检测是临床作为类风湿关节炎患者判断病情和估计预后有价值的指标之一,值得进一步探讨。     

尿hGH测定在肢端肥大症诊断中的价值

应用尿hGH免疫放射测定法,测定了12例成年男性、12例成年女性和17例肢端肥大症夜10小时尿hGH排泄量,分别为0.58±0.56ng,0.52~0.37ng和167.1±278.2ng。肢端肥大症夜10小时尿hGH排泄量显著高于正常人(P<<0.001),且无一例重叠。通过8例肢端肥大症上午8小时血清hGH谱与夜10小时尿hGH排泄量的观察,发现两者呈显著相关,提示夜晚和日间可能有相同的hGH分泌模式,尿hGH排泄量测定能够反映血清hGH分泌情况。提示,用本法测定尿hGH排泄量有助于诊断肢端肥大症。     

A RECEPTOR ASSAY FOR THE MEASUREMENT OF TSH RECEPTOR ANTIBODIES IN UNEXTRACTED SERUM

A receptor assay for TSH receptor antibodies is described in which unextracted serum, detergent solubilised TSH receptors and 125I-labelled TSH are used. The assay was rapid and reproducible with coefficients of inter-assay variation of 12.3%, 2.1 and 2.6% at mean inhibition of TSH binding values of 11, 53, and 79 respectively. Assay sensitivity could be increased by reducing the volume of receptors used but some increase in the scatter of values obtained with individual normal sera was also observed. Comparison of human and porcine TSH receptor preparations indicated that porcine tissue gave greater sensitivity. Analysis of different groups of patients and normal subjects (n = 21) showed the absence of detectable TSH receptor antibody activity in 16 patients with rheumatoid arthritis, 10 with multinodular goitre and 12 with Hashimoto's disease. However the antibody was readily detectable in 28 out of 28 Graves' patients (treated and untreated) who were hyperthyroid at the time of assay.     

晚期血吸虫病血清透明质酸测定的临床价值

本文报告血清透明质酸（HA）测定对115例不同类型血吸虫病患者的诊断价值。结果表明，各型血吸虫病患者血清HA含量均增高，与对照组比较，有非常显著差异（P＜0.01）。其中以晚期血吸虫病（下称晚血）患者增加更为显著。在排除其它疾病所致的HA增高后，以血清HA＞300μg／L作为诊断晚血的一项指标，符合率达93．68％。对51例晚血患者同时做血清白蛋白测定，结果显示，HA测定的真阳性率达92.16％，远高于白蛋白。本文提示，血清HA测定可作为诊断晚血的敏感指标之一。对反映血吸虫病肝纤维化轻重程度也具有重要意义，并有助于慢性血吸虫病与晚血的鉴别诊断。     

THE MEASUREMENT OF SERUM THYROGLOBULIN IN THE PRESENCE OF THYROGLOBULIN ANTIBODIES

In a significant proportion of patients with thyroid disorders, thyroglobulin antibodies (TgAb) invalidate double-antibody radioimmunoassays (RIA) for thyroglobulin (Tg). A modified RIA procedure for determining serum Tg in the presence of TgAb, is described. Two measurements are made on each sample.

• a Ratio of immunoglobulin (Ig)-bound thyroglobulin to free thyroglobulin (bound:free ratio). This is measured by the distribution of a trace quantity of ¹²⁵I-Tg between bound and free fractions.
• b Concentration of free, i.e. unbound thyroglobulin. This is measured in the supernatant after precipitation of IgG-bound Tg.

Then, bound Tg = B:F x (free Tg) and total Tg = (bound Tg) + (free Tg). Critical factors examined in the validation of the modified method were: (1) use of immunologically intact ¹²⁵I-Tg (specific activity ± 5 mCi/mg); (2) equilibration of tracer Tg with endogenous serum Tg, and (3) clean separation of IgG-bound and free fractions of Tg with goat anti-human IgG. Recovery of added Tg in the presence of TgAb was 105% and interassay precision of total Tg assay was ≤ 9·3%. In euthyroid subjects without TgAb, the correlation between total Tg levels by the modified and standard double-antibody method was 0·931. The correlation was much poorer in the presence of TgAb (r = 0·752) reflecting their interference in the standard method. Reference ranges for serum total Tg levels by the modified method in euthyroid, hyper-and hypothyroid subjects with and without TgAb are detailed.     

THE POSSIBLE ROLE OF SHIGELLA IN SPORADIC ENTERIC REACTIVE ARTHRITIS

Reactive arthritis (ReA) occurs after a urogenital infectionusually with Chlamydia trachomatis or an enteritis due to Yer-sinia,Salmonella, Campylobacter or Shigella, Shigella, except duringepidemics, is not considered to be a frequent cause of entericreactive arthritis. However this might be due to the lack ofa reliable antibody test, which makes diagnosis difficult. Wecompared synovial and peripheral blood lymphocyte proliferationto various bacterial antigens in 19 consecutive patients withReA or undifferentiated oligoarthritis. In five patients Shigellawas identified as the causative microbe by a specific synoviallymphocyte proliferation. All five patients had a history ofsymptomatic diarrhoea and had negative stool cultures by thetime arthritis developed. Four of the five were HLA B 27 positive.We conclude that Shigella may be underestimated as a cause ofnon-epidemic ReA. KEY WORDS: Reactive arthritis, Shigella, Antigen specific lymphocytes, Synovial fluid