抗心磷脂抗体与各类流产的关系

目的：探讨抗心磷脂抗体（ACA）与流产的关系。方法：对80例正常初孕妇（对照组）和93例流产孕妇（流产组，其中先兆流产62例，难免流产21例，过期流产10例）采用酶联免疫吸附法测定血清抗心磷脂抗体IgM。结果：①流产组ACA阳性率明显高于对照组（P＜0.05)。②有流产史者较无流产史ACA阳性率明显增高（P＜0.05)，习惯性流产史与非习惯性流产史间ACA阳性率差异无显著性（P＞0.05)。结论：ACA阳性可能与自然流产有关，但ACA阳性与是否习惯性流产无明显关系。     

暴发型伤寒患者抗心磷脂抗体的检测及临床意义

目的：为了解血清抗心磷脂抗体（ACA）检测在暴发型伤寒患者中的临床意义。方法：采用ELISA法检测84例暴发型伤寒患者和104例临床对照血清中ACA。结果：表明暴发型伤寒患者ACA阳性等（17．85％）与正常对照组ACA阳性率（3．85％）相比有显著性差异（P＜0．01）,在暴发型伤寒患者中,并发有中毒性肝炎38例,随着患者ALT的升高,ACA阳性率明显增高。结论：ACA与伤寒患者的病情有关,检测伤寒患者ACA是监测患者有无合并肝功能损害的良好指标。     

37例复发性流产患者抗心磷脂抗体的测定及分析

目的探讨抗心磷脂抗体（anticardiolipina antibodies,ACA）阳性对妊娠结局的影响。方法用酶联免疫吸附实验（enzyme—linked immunosorbent assay,ELISA）方法检测37例复发性流产患者体内的ACA,并与正常组对照。结果37例复发性流产患者ACA阳性17例,阳性率45．95％。正常对照组108例,ACA阳性9例,阳性率8．33％。结论抗心磷脂抗体是一种测定自体免疫功能的方法。ACA阳性的孕妇由于胎盘内血栓形成,可导致胎盘功能不全,故临床上妊娠的结局多为胚胎停育,复发性流产。因此,抗心磷脂抗体的测定对于预测妊娠结局,维持早期妊娠具有重要意义。     

早期自然流产与抗心磷脂抗体的关系

目的探讨早期自然流产与抗心磷脂抗体的关系。方法收集57例有早期自然流产史妇女（观察组）和40例无自然流产史妇女（对照组）进行抗心磷脂抗体检测。结果（1）观察组抗心磷脂抗体阳性19例，阳性率33．33％，对照组抗心磷脂抗体阳性3例，阳性率7．50％，两组阳性率比较，有显著性差异（P〈0．01）；（2）有早期自然流产史妇女中抗心磷脂抗体阳性率与自然流产次数之间无正相关关系。结论早期自然流产与抗心磷脂抗体有关，其阳性率与流产次数无关。     

抗心磷脂抗体与脑卒中关系的探讨

目的：检测血清抗心磷脂抗体（ACA）并探讨其与脑卒中的关系。方法：使用酶联免疫吸附试验（ELISA）,检测76例脑梗死患,42例脑出血患以及50名正常人的血清ACA。结果：脑梗死组ACA阳性率为39．47％,与脑出血组（19．05％）和正常对照组（8．00％）比较差别具有显性（P＜0．05,P＜0．01）,脑出血组ACA阳性率虽高于正常对照组,但无统计学意义（P＞0．05）。进一步分析,复发性脑梗死患和首发性脑梗死患ACA阳性率分别为61．90％和30．91％,两比较差异有显性（P＜0．05）。脑梗死组中ACA亚型以IgG型阳性率较高（。69％）。结论：ACA与缺血性脑卒中的发病有一定关系,尤其与复发性脑梗死关系更为密切,ACA检测对缺血性脑卒中的预防、治疗和病情预后评估有价值。     

肾移植术后巨细胞病毒检测的临床意义

目的　探讨肾移植术后检测巨细胞病毒感染的意义。方法　利用酶联免疫吸附法 (Enzymelinkedimmunosor bentassay ,ELISA)以及聚合酶链反应 (Polymerasechainreaction ,PCR)检测肾移植术后受者血清中的抗 CMV抗体及CMV DNA。结果　检测了 72例肾移植术后的受者抗 CMV抗体及CMV DNA ,抗 CMV抗体及CMV DNA阳性率均明显高于术前(P <0 0 1) ,其中 2 5 %的CMV感染者发展为CMV病。移植术后CMV DNA阳性者发生急性排斥反应的几率明显高于CMV DNA阴性者。结论　检测肾移植受者血清中的抗 CMV抗体及CMV DNA可以协助诊断肾移植受者是否感染CMV以及引起的CMV病 ,对临床治疗肾移植术后CMV病有着重要的意义     

癫痫病人抗心磷脂抗体的检测

目的探讨抗心磷脂抗体（ACA）与癫痫发病的关系。方法比较48例癫痫病人及44例健康体检者血清中ACA阳性率。结果癫痫组ACA阳性率较对照组显著增高（χ^2=12.64,P〈0.01）;服用抗痫药3个月后癫痫病人血清中ACA阳性率与服药前相比无明显差异。结论抗心磷脂抗体与癫痫发病可能相关,抗心磷脂抗体可能是癫痫的致病因素之一。     

急性心肌梗塞患者血清抗心磷脂抗体含量变化的研究

目的　探讨抗心磷脂抗体 (ACA)与急性心肌梗塞的关系。方法　应用ELISA法测定 3 6例急性心肌梗塞患者和正常对照组血清中的ACA。结果　急性心肌梗塞患者ACA的阳性率 (3 8.89% )明显高于正常对照组 (χ2 =12 .96,P<0 .0 0 1)。结论　ACA检测对急性心肌梗塞有一定的预报价值     

子宫内膜异位症并不孕患者血清中抗心磷脂抗体和检测

目的：探讨子宫内膜异位症（endometriosis,EM)并不孕患者血清中抗心磷脂抗体（ACA）与其不孕的关系。方法：采用酶联免疫吸附法检测EM患者血清中ACA的阳性率。结果：EM患者血清ACA的阳性率显著高于正常育龄妇女。结论：EM患者血清中ACA的阳性率升高，可能是其不孕的原因之一。     

肾移植术后巨细胞病毒感染与急性排斥反应

目的：探讨肾移植术后活动性巨细胞病毒（CMV）感染的发生率、原因以及急性排斥反应的影响。方法：检测182例肾移植受者及其供者术前血清抗CMV抗体,受者术后定期PCR法检测体内CMV DNA,对CMV DNA阳性的部分患者给予抗CMV治疗,并比较各组排斥反应的发生率。结果：无论是供者还是受者,术前如血清抗CMV抗体阳性,受者术后发生活动CMV感染者明显增多,且急性排斥反应的发生率亦明显增加;接受抗病毒治疗急性排斥反应明显减少。结论：CMV感染是肾移植术后急性排斥反应的原因之一,预防和治疗CMV感染对肾移植术后急性排斥反应的防治具有重要意义。     

肾移植受者外周血白细胞CMV抗原阳性细胞数及意义

【目的】探讨肾移植受者外周血白细胞巨细胞病毒(CMV)PP-65抗原阳性细胞数的变化及意义。【方法】用免疫细胞化学法检测外周血白细胞CMV-PP65抗原,术后头3个月每周1次。【结果】273例肾移植受者中124例术后检出CMV-PP65抗原阳性,初次检出CMV-PP65抗原的平均时间为(24.1±11.3)d,每5万白细胞中CMV抗原阳性细胞数均值为7.1±5.8,其中5例CMV抗原阳性细胞数超过10/5万白细胞。无症状性和症状性CMV感染受者初次检出CMV抗原阳性细胞数分别为(6.7±5.6)/5万白细胞、(10.1±9.3)/5万白细胞(P>0.05);峰值水平为(8.1±4.2)/5万白细胞、(26.3±5.7)/5万白细胞(P<0.05);分别有17例(15%)、12例(100%)患者其峰值超过10/5万白细胞(P<0.05)。抗病毒治疗中90例(72.6%)患者CMV抗原阳性细胞数进一步升高。【结论】肾移植受者在CMV感染早期病毒复制能力强,CMV抗原阳性细胞数峰值有助于预测症状性CMV感染。     

Clinical application of real time-polymerase chain reaction in determining cytomegalovirus viral DNA load in renal transplant recipients

Background Cytomegalovirus (CMV) remains a significant clinical problem among immunosuppressed renal transplant patients.Quantitative PCR assays have become the most common methods in the determination of CMV infections in transplant patients.This study was to determine the relationship between CMV infection and the acute rejection of the transplanted kidney.Methods Plasma samples from 77 renal transplant patients that were pre-transplant negative for CMV infection were tested using real-time quantitative PCR and CMV gene-specific primers.The detected viral loads were retrospectively compared with the acute rejection rate and the chronic or mild rejection rates of the renal transplant.Results CMV-DNA was detected in 29 of 77 recipients,yielding a positive rate of detection of 37.7％ for this procedure.Twelve of the 21 recipients (57.1％) who suffered acute rejection had positive CMV-DNA.Among the 56 recipients suffered from chronic or mild rejection,17 (30.4％) had positive CMV-DNA plasma.Moreover,of the 29 recipients who had detectable CMV-DNA after transplant,12 (41.4％) suffered from acute rejection; of the 48 recipients with undetectable CMV-DNA,only nine (18.8％) developed acute rejection.Post-transplant patients with acute rejection had a higher rate (57.1％ vs.30.4％,P=0.03) of post-transplant CMV infection than those with chronic or mild rejection.Conclusion CMV infection is a risk factor of acute renal transplant rejection and CMV infection should be prevented and treated in renal transplant recipients.Chin Med J 2012; 125(19):3575-3577     

术前巨细胞病毒感染对肾移植的影响

目的探讨术前巨细胞病毒(cytomegalovirus infection,CMV)感染对肾移植术后急性排斥反应(acute rejection,AR)的影响及术前预防性抗病毒治疗的意义.方法回顾性分析了116例肾移植受体的术前CMV感染和预防性抗病毒治疗情况,根据术前有无CMV感染分为感染组和非感染组,将CMV感染组肾移植受体根据有无预防性抗病毒治疗分为治疗组和非治疗组.同时检测35例正常健康者CMV结果.采用检测CMV-PP65抗原诊断CMV感染.结果术前CMV感染率肾移植受体为63.8%(74/116)高于正常健康者14.3%(5/35).术后发生CMV感染或CMV病非治疗组为5例(15.6%)高于治疗组1例(2.4%).发生急性排斥反应的术前CMV感染组为14例(18.9%)高于非感染组2例(4.8%).术后发生AR治疗组为4例(9.5%)低于非治疗组10例(31.3%).结论肾移植受体术前CMV感染发生率高于正常健康人群.预防性抗病毒治疗可以降低术后CMV感染或CMV病的发生率.术前CMV感染的肾移植受体术后AR发生率高于非感染者.对术前CMV感染患者采取预防性抗病毒治疗可以降低术后AR的发生率.     

Primary cytomegalovirus and opportunistic infections. Incidence in renal transplant recipients.

Thirty-five renal allograft recipients were studied concerning the relationship between cytomegalovirus (CMV), herpes simplex virus (HSV), and opportunistic bacterial and fungal infections. The incidence of opportunistic infections was determined for patients whose tests prior to transplantation were seronegative in complement fixation and indirect hemagglutination assays of CMV antibody and for those patients whose tests were seropositive. Among the six seronegative patients with seronegative tests, four (66%) experienced active CMV infection within two months, and four died of Candida or Aspergillus infection within six months after transplantation. Among the 22 patients with seropositive tests, only one (4%) had a fungal infection and it was nonfatal (P less than .05). The increased morbidity and mortality due to fungal and bacterial infections in transplant recipients with seronegative CMV tests appears, therefore, to be related to primary CMV infection rather than to generalized immunodeficiency.     

肾移植术后巨细胞病毒感染与急性排斥反应

目的 :探讨肾移植术后活动性巨细胞病毒 (CMV)感染的发生率、原因以及对急性排斥反应的影响。方法 :检测 182例肾移植受者及其供者术前血清抗CMV抗体 ,受者术后定期PCR法检测体内CMVDNA ,对CMVDNA阳性的部分患者给予抗CMV治疗 ,并比较各组排斥反应的发生率。结果 :无论是供者还是受者 ,术前如血清抗CMV抗体阳性 ,受者术后发生活动性CMV感染者明显增多 ,且急性排斥反应的发生率亦明显增加 ;接受抗病毒治疗急性排斥反应明显减少。结论 :CMV感染是肾移植术后急性排斥反应的原因之一 ,预防和治疗CMV感染对肾移植术后急性排斥反应的防治具有重要意义。     

肾移植术后感染的临床特征及病原学研究

目的：探讨我院肾移植术后感染的临床特点,为提高肾移植术后感染的治愈率及改善受者预后提供参考依据。方法：收集2010年1月至2013年1月因肾移植术后感染入我院的124名感染患者的病例资料。回顾性分析感染发生时间、感染部位、免疫抑制方案、免疫抑制剂药物浓度、实验室检查结果、病原学检查资料。重点分析肾移植术后社区获得性肺炎、重症肺炎及细菌耐药性。结果：①124名肾移植术后感染患者共发生166次感染,16人至少发生2次感染（16.8％）。②84例肾移植术后社区获得性肺炎最常发生于术后2～6月。40例病原学诊断明确（46.4％）,细菌感染最为常见（35％）,其后依次为混合感染（22.5％）、巨细胞病毒感染（20％）。③术后2~6月为重症肺部感染的高发时间段。10例病原体诊断明确（58.82％）,细菌感染4例（23.53％）,混合感染3例（17.65％）,真菌感染2例（11.77％）。结论：呼吸道及泌尿道为肾移植术后感染的常见部位,肾移植术后感染最常发生于术后2~6月,不同时期肺炎具有不同的临床特点,分离病原体以细菌为主,细菌对常用抗生素耐药情况严重。     

CYTOMEGALOVIRUS AND EPSTEIN-BARR VIRUS INFECTION IN RENAL TRANSPLANT RECIPIENTS

23 renal transplant recipients were fot.rnd to be sensitive to CMV and EBV infection. The infection began early after transplantation, with increase of the titer of antibody to CMV. The peak infection with CMV occurred in 8-12 weeks in most cases, while EBV infection occurred mainly in the 3rd month.     

Cytomegalovirus infection as a complication of OKT3 therapy in kidney transplant recipients

We compared the incidence of clinical CMV illness in 25 renal transplant recipients treated with OKT3 for steroid resistant cellular rejection with 88 renal transplant patients treated only with conventional immunosuppression (cyclosporin A and steroids). Nine (36%) patients in the OKT3 group developed CMV illness compared to (2.3%) amongst those treated conventionally (p<0.0005). Patients who received OKT3 were divided into four groups according to the CMV antibody status of the donor and recipient. Six of the 9 episodes of CMV infection occurred in patients not previously exposed to CMV, who received a kidney from a CMV positive donor. Three (12%) of the patients treated with OKT3 died of CMV disease. A further 2 patients died of other causes giving an overall mortality in the OKT3 treated group of 20%. We concluded that when OKT3 therapy is used in association with donor/recipient CMV mismatch it is associated with a high CMV morbidity and mortality.     

2剂赛尼哌预防肾移植术后急性排斥反应的应用研究

目的 :探讨赛尼哌在预防同种肾异体移植术后急性排斥反应的作用。方法 :回顾分析了已随访 1年的 32例应用 2剂赛尼哌患者的临床效果 ,并以同期肾移植 92例作为对照组。结果 :赛尼哌组在 3月内急性排斥反应发生率 (3.1% )显著低于对照组 (2 3.9% ) (P <0 .0 5 ) ,在感染及副作用方面与对照组无显著性差异。结论 :2剂赛尼哌加上CsA ,MMP ,Pred联合应用的免疫抑制方案对预防同种尸体肾移植受者的急性排斥反应的发生是安全有效的。     

Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts

Thirty-one immunocompromised patients with severe cytomegalovirus (CMV) disease were treated with intravenous ganciclovir. Twenty-one patients had received transplants--15 bone marrow recipients, five renal allograft recipients, and one liver transplant recipient--while the other ten were immunocompromised due to acquired immunodeficiency syndrome (six), hematologic malignancies (three), and systemic lupus erythematosus (one). They presented with one or more of the following syndromes: CMV pneumonitis (19), CMV of the gastrointestinal tract (six), CMV retinitis (seven), and CMV hepatitis (three). Seventeen (55%) of 31 patients demonstrated clinical improvement during ganciclovir therapy, with the best response seen in the transplant recipients. Viremia ceased in 14 (93.3%) of 15 patients after a mean of 4.7 days of therapy; viruria ceased in eight (53.3%) of 15 patients after a mean of 11 days of therapy. Ganciclovir plasma concentrations at a dosage of 2.5 mg/kg/three times a day were as follows: mean peak, 16.04 mumol/L; mean trough, 2.38 mumol/L. Neutropenia occurred in 11 (35%) of 31 patients and in nine (60%) of 15 bone marrow transplant recipients. We conclude that ganciclovir exerted an antiviral effect against CMV and may play a role in the treatment of CMV disease in patients with depressed immunity, especially bone marrow and organ transplant recipients.