麻风病

20052965麻风病免疫中的树突状细胞与T细胞的相互作用及其研究进展/翁小满(首都医大附属北京友谊医院北京热带医学研究所),胡永秀∥中国麻风皮肤病杂志.-2005,21(3).-200~203综述了有关麻风病在抗原递呈及诱导T细胞反应的研究;比较和分析DC递呈麻风菌及麻风菌组分抗原及其诱导不同的T细胞反应的机制;揭示了麻风菌是一个很独特的致病性分枝杆菌,它可能含有阻碍DC与T细胞相互作用的成分,而DC递呈麻风菌的组分抗原都可活化T细胞,这为逆转免疫无反应性的研究提供借鉴。参16(马宽玉)20052966酚糖酯-免疫球蛋白M和鼻分泌物中麻风菌PCR检测在麻风流行病学中的应用/翁小满(北京热带医学研究所),温艳,袁联潮…∥中国麻风皮肤病杂志.-2005,21(6).-425~428采用酚糖酯-酶联免疫吸附试验(PGL-ELISA)和检测鼻携带麻风菌的PCR方法,对流行乡村(云南省同烘和南丘)麻风病患者、家内接触者及普通人群麻风菌感染进行检测。结果:麻风病家内接触者的PGL-IgM阳性率和PCR检测的麻风菌携带率分别为30.4%和23.1%,两村普通村民PGL-IgM阳性率南丘村18.7%,同烘村20.86%,无...     

免疫组织化学和PCR在早期麻风诊断中的应用

目的：探讨PCR、免疫组化应用于早期麻风诊断的价值。方法：采用PCR、免疫组化（PGL－1）和常规病理（HE、Fite抗酸染色）3种方法并用于临床诊断麻风病，用病理检查呈轻度非特异性炎症，查菌阴性的46例石蜡组织块，重新连续切片作对比观察。结果：3种检查结果比较，PCR阳性率（58．7％）＞PGL－1（36．9％）＞抗酸染色查菌AFB（15．2％），P＜0．05。结论：PCR、免疫组化两种检测技术，用于早期少菌型麻风的诊断比常规病理检查具有较高的敏感性和特异性。     

鼻分泌物及皮肤组织中麻风菌及共PGL—1抗原的检测

为了更好地理解麻风菌处携带在麻风病传播，维持中的作用，以及运用鼻携带检测来评价麻风病防治效果，比较了ＰＣＲ和Ｄｏｌ－ＥＬＩＳＡ／ＥＣＬ平行检测３２例活动性麻风患者，１３例愈后者和１４３名麻风家内接触者鼻分泌物及皮肤组织中的麻风菌及其ＰＧＬ－１抗原。     

2235例麻风垂足的分析

目的：了解麻风垂足的患病情况，为制定预防措施提供科学依据。方法：选择江苏11个县市存活的麻风治愈者及现症患者为调查对象，资料输入计算机统计分析。结果：麻风垂足的患病率为15．7％，单足（13．62％）高于双足（2．07％），男性（16．36％）高于女性（13．84％）,现症及复发病人（31．28％）高于治愈者（15．07％），BT、BB型麻风占23．56％及20．96％。麻风病期在5年以内发生垂足的少菌型麻风（72．41％）高于多菌型（50．47％）；发生过麻风反应的患者垂足占33．75％。垂足有足底溃疡（21．21％）、足骨破坏（19．17％）及足畸形（27．43％）多于无垂足的溃疡（15％）、骨破坏（15．09％）及足畸形（20．19％）。989只垂足可通过手术矫治，要求治疗者只占30％。结论：麻风垂足以男性、现症及复发病人多见且以单足为主，垂足发生的足底溃疡及足畸形明显增多，三分之二的垂足失去了手术矫治的机会，70％的患者对垂足的治疗没有信心。麻风垂足的发生与麻风诊断和治疗的延迟、麻风反应及麻风型别的不同有明显的关系。     

ELISA和明胶微粒凝集试验检测麻风病人及接触者血清抗体

用半合成酚糖脂抗原(NT-O-BSA)间接酶联免疫吸附试yan(ELISA)和半合成爵糖脂抗原(NT-P-BSA)致敏明胶微粒凝集试验(MLPA).检测贵州省12县麻风病人密切接触者血清抗体1715例,现症麻风病人137例:结果:接触者阳性率ELISA和MLPA分别为17.84%和13.94%(R=4.8514,P=0.0004);麻风病人阳性率分别为91.97和89.78% (X²=0.0083,P>0.5,在活动性肺结核病人及正常人的结果相同和相近.上述结果表明ELISA和MLIPA具有较高的敏感性和较好的特异性,且接触者血清抗体阳性率与各地麻风病患病率和发病率呈显著正相关.提示接触者抗体测定除可作为检测麻风菌感染外也许还可预测麻风病的流行.     

M-Dot-ELISA检测麻风家内接触者血清中麻风杆菌特异性抗原

用改良酶联免疫斑点１５试验（简称 Ｍ－Ｄｏｔ－ＥＬＩＳＡ）对麻风家内接触者（ＨＣ）血清进行了麻风杆菌特异性酚酚糖脂Ｉ（ＰＧＬ－Ｉ）抗原检测。７５例ＨＣ均经麻风杆菌明胶微粒凝集试验（ＭＬＰＡ）和酶联免疫吸附试验（ＥＬＩＳＡ）证实为麻风杆菌特异性抗体阳性者。结果表明：①７５例ＨＣ中抗原阳性者１６例，阳性率为２１％。接触多菌型麻风（ＭＢ）者的抗原阳性率（２８％）明显高于接触少菌型麻风（ＰＢ）者（０％），两者之间有极显著性差异（ Ｐ ＜０．０１ ）。②抗体弱、强阳性组的抗原阳性率和抗原量之间亦有极显著差异（Ｐ＜０．０１）。③４０例正常人及１０例经ＭＬＰＡ和ＥＬＩＳＡ检测证实特异性抗体阳性的非麻风患者血清标本，抗原检测均阴性。     

不同发病年龄组麻风性别构成分析

本文对江苏省建湖县登记的麻风病例依不同发病年龄组男女发病专率的差异以及形成这种差异的原因 ,进行了分析。资料分析　为本院收集的历年麻风防治资料及麻风病人个案资料。总数 6 71例 ,其中男 4 74例 ,女 197例 ,男女之比为2 .4 1:1;ＭＢ 14 0例 ,ＰＢ 5 31例 ,ＭＢ/ＰＢ为0 .2 6 ;0～ 14岁儿童 90例 (13.4 1% ) ,15～ 5 4岁青中年 4 94例 (73.6 2 % ) ,5 5岁以上老年人 87例 (12 .97% )。年龄、性别、型别关系概况见表 1。表 1　 6 71例麻风年龄、性别、型别关系年龄组 (岁 )总数 　男　　女　ＭＢＰＢＭＢＰＢＡ 0～ 14 90 94 6 92 6Ｂ…     

江西省麻风流行病学分析

目的总结江西省50年来麻风防治工作的成果和经验,为今后制订麻防工作新策略提供理论依据.方法收集江西省建立的历年<麻风疫情监测系统>资料,利用计算机进统计和分析.结果江西省历史上属麻风中度流行区,且有南高北低的地理分布特点.麻风病年发现率、发病率及患病率均以50、60年代为高峰,以后呈逐年下降趋势.1998年底的各项指标为历史最低水平,其中5年平均发现率(0.1604/10万)、患病率(0.049/万)已达到部颁摶鞠饠麻风标准;但全省92个县、市中尚有15个县、市摿铰蕯高于摶鞠饠标准.结论早期发现患者,及时联合化疗,开展各种形式的麻风知识宣传教育,可以有效地控制麻风的流行.     

莆田市麻风流行病学分析

莆田市曾是福建省麻风病高流行区之一，至2001年底，全市累计发现麻风病患者3502例，其中多菌型1096例，少菌型2406例，男2554例，女948例，治愈2840例，自愈2例，未愈死亡491例，外迁73例，其他减少141例。至2001年底尚有现症病人26例，患病率0．086／万。现就我市麻风流行情况分析如下。     

麻风菌抗原诱导IL-12产生的体外研究

目的:检测麻风菌不同抗原脂蛋白诱导单个核细胞(PBMC)IL-12p40分泌水平.方法:以麻风菌不同抗原刺激体外培养的少菌型(PB)、多菌型(MB)麻风患者及健康接触者PBMC,加入或不加外源性IFN-γ共培养,ELISA检测培养上清的IL-12p40分泌水平.结果:(1)麻风菌胞浆抗原(MLSA)和麻风菌33KDa脂蛋白可诱导健康接触者、PB患者PBMC分泌IL-12p40;(2)外源性IFN-γ可上调健康接触者和PB患者PBMC分泌IL-12p40水平.结论:麻风菌33KDa脂蛋白是PB患者IL-12p40的有效诱导剂,外源性IFN-γ可上调IL-12p40分泌,为麻风病免疫治疗的建立提供了依据.     

Experiences with Mycobacterium leprae soluble antigens in a leprosy endemic population

Rees and Convit antigens prepared from armadillo-derived Mycobacterium leprae were used for skin testing in two leprosy endemic villages to understand their use in the epidemiology of leprosy. In all, 2602 individuals comprising 202 patients with leprosy detected in a prevalence survey, 476 household contacts and 1924 persons residing in non-case households were tested with two antigens. There was a strong and positive correlation (r = 0.85) between reactions to the Rees and Convit antigens. The distribution of reactions was bimodal and considering reactions of 12 mm or more as 'positive', the positivity rate steeply increased with the increase in age. However, the distributions of reactions to these antigens in patients with leprosy, their household contacts and persons living in non-case households were very similar. These results indicate that Rees and Convit antigens are not useful in the identification of M. leprae infection or in the confirmation of leprosy diagnosis in a leprosy endemic population with a high prevalence of nonspecific sensitivity.     

Utility of serodiagnostic tests for leprosy: a study in an endemic population in South India

In order to evaluate the usefulness of natural disaccharide (PGL1) and 35 kDa antigens based serology in diagnosis of leprosy and in detecting high risk groups for leprosy, this study was conducted in an endemic population in South India. Out of 3346 cases and their households and neighbouring household contacts, serum samples from 2994 and 2875 individuals were screened for antibodies against PGL1 and 35kDa antigens respectively. While the overall positivity for contacts and leprosy cases was 3.3% for PGL1 antibody, the positivity for 35 kDa antibody was 6.3%. The positivity for contact population was 2.7% and 5.4% for PGL1 and 35 kDa antibodies, respectively. Lepromatous and borderline lepromatous patients showed positivity of 35.1% for PGL1 antibody and 45.7% for 35 kDa antibody. Follow-up of contacts showed that the majority (>90%) remained seronegative for both the antibodies and most of the new cases emerged from the seronegative group. The study clearly indicates that specific serological assays are not sensitive enough for application, both for diagnosis and for identifying any individual at risk for leprosy in the south Indian endemic population.     

鼻分泌物及皮肤组织中麻风菌及其PGL-1抗原的检测

为了更好地理解麻风菌鼻携带在麻风病传播、维持中的作用，以及运用鼻携带检测来评价麻风病防治效果，比较了PCR和Dot-ELISA／ECL平行检测32例活动性麻风患者、13例愈后者和143名麻风家内接触者鼻分泌物及皮肤组织中的麻风菌及其PGL-1抗原。结果显示，Dot-ELISA／ECL具有较好的敏感性、特异性，是一项适用于现场研究的简便、快速、经济的麻风流行病学工具。此外，用于免疫学试验，GVHP是一种吸附性好，适合于检测粘膜分泌物抗原的载体。     

Features of leprosy transmission in pocket villages at low endemic situation in China

To study the characteristics of leprosy transmission at low endemic situation and to analyze the reason why transmission still existed. A retrospective study was carried out on transmission of leprosy in thirteen leprosy high endemic villages in Wenshan district, Yunnan Province, China. A special questionnaire was designed for collecting the data. A total of 47 patients have been registered in 13 villages since 1991. Among them, 25 (53.2%) were leprosy household patients. The proportion of BI positivity was 57.4% (27). The average delay time from disease onset to diagnosis of leprosy was 12 +/- 7.9 months with a range of 1-36 months. The interval between 2 cases being detected in each village was in a range of 0.5 to 5.5 years. Many secondary patients occurred continuously after an 'index case' and they developed leprosy within the delay time of the disease of former patients. The authors here also reviewed some literature on chemoprophylaxis and discussed the importance. Most patients could not be detected at the early stage. It may be necessary of considering the chemoprophylaxis strategy among close contacts of leprosy to stop transmission in leprosy pocket areas.     

麻风病血清流行病学调查与化学预防的实施

目的:评价化学预防的保护性,本研究依据血清流行病学调查,对两个麻风病高流行村麻风病接触者和一般人群实施利福平化学预防.方法:采用临床查体、检测血清酚糖脂-1(PGL-Ⅰ)抗体和鼻分泌物麻风菌,了解人群的麻风菌感染状况,为评价预防治疗效果提供科学依据.结果:YG村临床普查率达98%,发现早期病人2例;接触者血清PGL-Ⅰ抗体阳性率76%,麻风菌鼻携带率35%,预防服药率达98%.HG村临床普查率91%,发现早期病人1例,人群血清PGL-Ⅰ抗体受检率54%,其中血清PGL-Ⅰ抗体阳性率33%,服药率达85%.结论:对亚临床感染率较高的人群实施化学预防很有必要.预防后的发病率与血清学等实验室数据可为评价预防治疗提供依据.     

Mycobacterium leprae DNA in daily using water as a possible source of leprosy infection.

Some environmental factors were suspected to be sources of leprosy infection according to the results of total survey in the highly endemic villages in Indonesia. M. leprae DNA were detected by PCR from 21 out of 44 water sources used daily by villagers. Prevalence of leprosy among the people using PCR-positive water for bathing and washing was significantly higher than that among the people who used PCR-negative water. No significant difference in prevalence was, however, recognized in case of usage of negative or positive water for drinking. Water was regarded as a reservoir and infectious source of M. leprae. Transmission of leprosy through the contaminated water was strongly suggested by epidemiological analysis.     

Sub-clinical infection with Mycobacterium leprae in household contacts of leprosy

870 household contacts of leprosy patients were examined for sub-clinical infection with M. leprae by smear (skin and nasal), lepromin and FLA-ABS tests. 0.6%, 3.3%, 71.5% and 14.4% of the contacts were found to be positive for skin smear, nasal smear, lepromin and FLA-ABS tests respectively. An analysis of the results revealed that 4% of the lepromin positive contacts and 3.6% of the lepromin negative contacts were positive to both FLA-ABS and skin or nasal smear.     

An epidemiological study on Mycobacterium leprae infection and prevalence of leprosy in endemic villages by molecular biological technique.

One of the most important unsolved questions in epidemiology of leprosy is the highly uneven geographic distribution of the disease. There are many hyperendemic "pockets" in endemic countries. Little is known about the reasons why leprosy is hyperendemic in these areas. We conducted, therefore, a series of epidemiological studies on Mycobacterium leprae infection and prevalence of leprosy in North Maluku district, Maluku Province, Indonesia where leprosy is highly endemic. It was found that considerable number of general inhabitants are seropositive to various mycobacterial antigens and 27% of the villagers were carrying leprosy bacilli on their surface of nasal cavity. These results suggested the importance of M. leprae in the residential environment in infection of the leprosy bacillus and the resulting transmission of the disease. Based on these observations, we conclude that new preventive measures are essential for global elimination of leprosy in addition to early diagnosis and multidrug therapy (MDT).     

麻风菌素试验和血清抗体检测联合监测麻风高危人群

为了早期发现麻风患者，应用麻风菌素试验和血清抗体检测方法在云南省文山州分别监测１９２例和１０６例初次检测抗ＮＤ－ＢＳＡ抗体阳性的自然人群和麻风患者家属发病情况，时间２年。在麻风菌素反应阴性和血清抗体阳性的自然人群和患者家属中分别发现１例和３例多菌型麻风。认为麻风菌素阴性和血清抗体持续阳性是发病的危险因素。两种方法相结合可鉴定出高危对象。此法在多菌型患者发病率较高的村庄可应用，有助于早期发现患者。考虑到费用较高，此法不推荐作为常规手段用于低流行区的麻风防治     

Comparison of PCR mediated amplification of DNA and the classical methods for detection of Mycobacterium leprae in different types of clinical samples in leprosy patients and contacts

Traditional staining and microscopic examination techniques for the detection of Mycobacterium leprae, DNA amplification by polymerase chain reaction (PCR) of a 531-bp fragment of the M. leprae specific gene encoding the 36-kDa antigen, and serodiagnosis with M. leprae specific antigens (PGL-1 and D-BSA) were compared on different clinical specimens (serum samples, slit-skin smears, biopsies and swabs) from 60 leprosy patients attending the Sanatorium of Fontilles. Patients were divided into groups; (i) 20 multibacillary patients (MB) with positive bacteriological index (BI) by conventional methods and on WHO multidrug therapy (MDT); (ii) 30 MB patients with negative BI and completed minimum 2 years treatment MDT; (iii) 10 paucibacillary (PB) patients who had completed 6 months MDT at least 8 years ago. Control groups included four non-leprosy patients for PCR methods and 40 health control patients and 10 tuberculosis patients for serological methods. In the multibacillary BI positive group, there was a good correlation between all methods. All tests were negative in the paucibacillary group, although only a few patients were tested and all had been treated many years ago. One must be cautious concerning the diagnostic potential of these techniques in this type of leprosy. We also studied different combinations of leprosy diagnosis methods to determine the potential risk in a leprosy contact individuals group. The prevalence of antibodies to M. leprae antigens in serum was measured, together with the presence of M. leprae DNA in the nose and lepromin status in a group of 43 contacts of leprosy patients (12 household and 31 occupational) to evaluate the maintenance of infection reservoirs and transmission of the disease. Only two individuals were found to form a potential high risk group.