老年人Ig,CIC和auto—Ab相互关系的研究

本文对不同年龄组健康人血清免疫球蛋白，循环免疫复合物和游离自身抗体的含量进行同步测定。结果发现，血清ＩｇＧ含量随增龄无明显改变，老年组ＩｇＡ明显高于青壮年组和老年前期组，而ＩｇＭ从４５岁便开始下降，老年人降低更为显著；老年组血清ＩｇＧ含量与ＣＩＣ－ＩｇＧ，ａｕｔｏ－Ａｂ－ＩｇＧ含量呈正相关。     

棘球蚴病CAb、CAg与CIC检测结果的评价

对棘球蚴病患者用ABC-ELISA法检测CAb,ABC-夹心双抗体法和Pernice法分别检测CAg和CIC,阳性率分别为87.0％(40/46)、15.6％(7/45)和17.8％(8/45)。在检测CAb阴性的6例中CAg阳性者4例,表明CAb与CAg同时检测可提高阳性检出率达95.6％(43/45)。 CAb阴性病例主要是肺棘球蚴病,占83.3％(5/6)。CAg的检出率仅15.6％,但特异性高,未出现交叉反应和假阳性反应。检测CIC不但检出率不高,而且非特异性反应与检测CAb时相似。     

IA-2Ab、GAD-Ab、IAA对1型和2型糖尿病的鉴别价值

对46例1型糖尿病（T1DM）患者、48例2型糖尿病（T2DM）患者,50例T1DM患者非糖尿病一级亲属（N-DMFR）及46例健康志愿者（NC）的酪氨酸磷羧酶抗体（IA-2Ab）、谷氨酸脱羧酶抗体（GAD-Ab）和胰岛素自身抗体（IAA）以及FPG、2hPG、HbA1c、胰岛素、C肽.结果IA-2Ab阳性者T1DM组为47.8%、N-DMFR组为28%,明显高于NC组（P＜0.05）;GAD-Ab阳性者T1DM组71.7%、N-DMFR组24%,明显高于NC组（P＜0.05）;IAA阳性者为T1DM组65.2%、T2DM组8.3%、N-DMFR组4.0%、NC组无阳性者.两种或两种以上抗体阳性者T1DM组63.0%,N-DMFR组6%;T2DM及NC组无检出者.IA-2Ab、GAD-Ab、IAA的联合检出有利于糖尿病的预测、早期诊断及正确分型.     

中药复方对实验性高脂血症豚鼠SOD、LPO、CIC含量与RCIA功能变化的影响和相关性研究

老年豚鼠喂饲高脂膳食形成老年高脂血症模型,然后再灌服具补肾化痰祛瘀作用的中药复方浓缩液4周。结果为造模后血中SOD活性、RBC-C_3bR花环率降低,血清LPO、CIC含量及RBC-IC花环率升高,与造模前及对照组比较,均具显著性差异。经服药后,SOD活性恢复,RBC-C_3bR花环率升高,LPO、CIC含量及RBC-IC花环率降低,与造模后比较,差异十分显著(P<0.005～0.001)。对SOD、LPO、CIC与RCIA功能的相关性研究表明,SOD活性与RBC-C_3bR花环率呈正相关,与RBC-IC花环率呈负相关;LPO、CIC含量则与之相反,并均具统计学意义。作者经分析认为老年高脂血症出现的上述变化均和自由基有关,且它们相互影响,互为因果,为导致AS及CHD的重要原因之一。提示该中药复方有预防和减轻高脂血症诱发AS、CHD的作用。     

克山病病区粮喂养大白鼠的免疫学实验研究和克山病患者的免疫状态初步探讨

本文报道了克山病病人的免疫功能变化及用克山病病区粮喂养大白鼠的免疫功能改变,研究结果表明,克山病病区人群的免疫功能一般偏低,慢性和潜在型克山病患者免疫球蛋白水平增高,尤以IgA和IgM为显著。克山病患者的抗核抗体阳性率增高,循环免疫复合物水平也有增高的趋势,患者心肌组织中有IgG的沉积,表明克山病患者有免疫学改变,并具有自身免疫反应特点;用克山病病区粮喂养大白鼠,可使其免疫功能受到一定影响,主要表现为T细胞数的减少及T细胞功能的降低,病区粮加硒后对其影响不明显,提示病区粮因素所致的机体免疫功能改变在克山病的发病过程中可能有一定影响,而硒可能只是免疫学改变的一个因素而已。     

特异性免疫球蛋白治疗44例流行性出血热临床分析

采用随机分组法用流行性出血热(EHF)特异性免疫球蛋白(SIG)治疗44例早期EHF患者,观察其特异性抗体水平、循环免免疫复合物(CIC)及补体C_3含量的动态变化,以探讨SIG对体液免疫应答的影响与作用。结果表明:应用SIG后,能明显降低EHF抗体及CIC水平,促进C_3水平回升。治疗组与对照组相比,差异显著及非常显著,P<0.05和P<0.01。提示早期应用SIG,可能有中和体内游离病毒,减轻病毒血症的作用,从而使由此激发的体液免疫水平降低,对减轻继发的免疫病理损害,阻止病情发展有一定的疗效     

血吸虫病患者血清CIC解离后特异性抗原／抗体检测的研究

将受检者血清免疫复合物（ＣＩＣ）用改进方法解离后，以多克隆、单克隆抗体（ＰｃＡｂ、ＭｃＡｂ）及可溶性血吸虫卵抗原（ＳＥＡ）作ＥＬＩＳＡ检测血吸虫特异性抗原（Ａｇ）及抗体（Ａｂ）。结果表明，检测ＣＩＣ解离后的Ａｇ（称为非游离性循环抗原，ＮＦ一ＣＡｇ）和Ａｂ（称为非游离性循环抗体，ＮＦ一ＣＡｂ），均显示满意的特异性和敏感性；用抗ＳＥＡ一ＰｃＡｂ与抗ＳＥＡ一ＭｃＡｂ和抗ＣＣＡ一ＭｃＡｂ对比检测ＮＦ一ＣＡｇ时，显示相似的检测效果；该法具有诊断病人和考核治疗效果的价值，且有互补诊断血吸虫病的效果。血清中ＣＩＣ解离后检测血吸虫特异性的ＮＦ一ＣＡｇ／ＮＦ一ＣＡｂ可望成为血吸虫病血清学诊断的新途径。     

糖尿病和牙周病临床相互关系的初步研究

目的研究糖尿病和牙周病的临床相互关系。方法选取2014年10月—2015年9月该院收治的伴有牙周病的糖尿病患者200例,根据治疗方法的不同将患者分为3组。仅对糖尿病进行治疗的67例患者为Ⅰ组,仅对牙周病进行治疗的66例患者为Ⅱ组,对糖尿病和牙周病进行系统治疗的67例患者为Ⅲ组。观察3组患者的治疗效果。结果Ⅲ组患者糖尿病治疗的有效率为92.54%,显著高于Ⅰ组的76.12%(P0.05);牙周病治疗的总有效率为95.52%,显著高于Ⅱ组的83.34%(P0.05)。结论糖尿病与牙周病之间存在相互依存的关系,临床上治疗糖尿病患者的牙周病时,应同时兼顾治疗糖尿病和牙周病,以提高疗效。     

原发性胆汁性胆管炎患者合并自身免疫性疾病外周血免疫T细胞亚群和免疫球蛋白及自身抗体的意义分析

[目的]分析研讨原发性胆汁性胆管炎(PBC)患者合并自身免疫性疾病外周血免疫T细胞亚群、免疫球蛋白及自身抗体的意义。[方法]随机选择2016-04-2019-02期间收治的102例PBC患者进行研究,根据其是否合并自身免疫性疾病划分为对照组(PBC患者,61例)和研究组(PBC合并自身免疫性疾病者,61例),均测定2组患者的自身抗体、免疫球蛋白、外周血免疫T细胞亚群指标等并比较。[结果]研究组CD4^+高于对照组,CD8^+、NK细胞低于对照组,差异有统计学意义(P<0.05);但CD4^+/CD8^+差异无统计学意义(P>0.05)。比较免疫球蛋白指标,IgA差异无统计学意义(P>0.05),研究组IgG、IgM高于对照组,差异有统计学意义(P<0.05)。比较补体水平,C3指标差异无统计学意义(P>0.05),研究组C4低于对照组,差异有统计学意义(P<0.05)。研究组抗胃壁细胞抗体、抗肝特异性蛋白、抗肝细胞膜抗体、抗可溶性肝抗原抗、抗肝肾微粒体抗体、抗平滑肌抗体、抗核抗体阳性率高于对照组,均差异有统计学意义(P<0.05)。[结论]临床可通过测定PBC合并自身免疫性疾病患者的补体水平、免疫球蛋白、外周血免疫T细胞亚群及自身抗体指标以诊断和评估病情。     

抗核抗体、抗双链DNA抗体研究与实验室检测的进展

随着自身免疫性疾病（autoimmune diseases，AID）研究的深入，自身抗体愈来愈受到临床的重视。出现了以自身抗体命名的疾病，如抗磷脂综合征、抗Jo21综合征，还出现了以自身抗体作为诊断标准和分型依据的疾病，如自身免疫性肝炎、原发性胆汁性肝硬化。这些自身抗体在AID中研究，均极大地加速了AID的诊疗进程。随着循证医学的发展，AID的实验室检查，     

C3-containing serum immune complexes in patients with systemic lupus erythematosus: correlation to disease activity and comparison with other rheumatic diseases

Summary Although testing for circulating immune complexes (CIC) is regarded as a useful, complementary, laboratory parameter in the differential diagnosis and management of immune complex-induced vasculitis syndromes, there is still an uncertainty with regard to assay systems used for the demonstration of soluble immune complexes. This is partly due to difficulties in the reproducibility, handling and principle limitations of available test systems for the assessment of soluble immune complexes in body fluids. In the present communication a modification of the anti-C3 test for the determination of CIC was developed using nitrocellulose as a solid phase matrix. IgG-, IgA- and IgM-containing CIC were determined and quantified using standard immune complex preparations. When 39 sera of SLE patients, 12 sera of patients with vascultis syndromes, 10 sera of rheumatoid arthritis patients and 11 sera of patients with ankylosing spondylitis were tested, predominantly IgG-containing CIC could be demonstrated. Only in SLE patients was a significant amount of other immunoglobulin isotypes detected in CIC. In these patients a significant difference of IgG-containing CIC levels was found with regard to patients with high and low disease activity (P<0.0001). A significant correlation was also established between IgG-containing CIC and anti-dsDNA antibodies (P<0.001). In a longitudinal study the isotypes in the isolated CIC were found to be constant.     

Some characteristics of neutrophils from diabetic patients and their relation to the levels of circulating immune complexes

Summary In the present work we studied different characteristics of neutrophils from diabetic patients and their relation to the levels of circulating immune complexes (CIC). Twenty-five insulindependent (IDD) and 25 non-insulin-dependent diabetic (NIDD) patients were evaluated. Each group was then subdivided according to the presence or absence of microvascular complications (MC). We found that the chemiluminescence (CL) emitted by opsonized zymosan (Zop) stimulated neutrophils in IDD and NIDD patients was significantly increased when compared to healthy subjects (p<0.01 and p<0.02, respectively). The CL values were correlated to CIC levels and both parameters were related to the presence of MC. On the other hand, the percentage of neutrophils capable of reducing nitroblue tetrazolium was diminished in the two groups of diabetic patients (p<0.05 for IDD and p<0.01 for NIDD). The percentage of neutrophils with functional C3b receptors was normal in diabetic patients; however, the proportion of phagocytic cells through Fc receptors was significantly decreased in both types of patients (p<0.05 and p<0.01 for IDD and NIDD, respectively). Furthermore, the number of granulocytes with immune complexes (IC) bound to their cell surface was increased in diabetics. We suggest that the increase of CIC level may produce an increase in IC binding to the neutrophil membrane. These IC could block the Fc receptors, diminish phagocytic capacity and, simultaneously, stimulate the release of toxic oxygen products, thus contributing to produce tissue damage.     

Spontaneous immunoglobulin synthesis by peripheral mononuclear cells in active rheumatoid arthritis

Summary Spontaneous production of immunoglobulins (Igs) by peripheral blood mononuclear cells (PBMC) in vitro was investigated to assess B cell activity in a group of 24 patients with rheumatoid arthritis (RA) with or without active joint disease and with or without rheumatoid vasculitis (RV) at the time of study. PBMC of patients with active arthritis (Ritchie index above 16) produced significantly more IgG and IgA than those of patients with inactive joint disease or those of 12 healthy controls. Enhanced production of IgG was found mainly among RA patients with concomitant RV, whereas markedly enhanced IgA production could also be found in patients without symptoms of RV. IgM production was only enhanced in two patients who had both active arthritis and RV. High production of IgG and IgA was probably due to increased numbers of Ig-secreting cells among freshly isolated PBMC, since the concentrations of Ig produced in vitro rose steadily, starting on day 0 and persisting throughout the entire culture period. Moreover, IgG and IgA concentrations measured after 7 days of culture showed significant correlations with the numbers of IgG- and IgA-containing plasma cells in PBMC on day 0. Comparison of the spontaneous production of Igs by PBMC with the levels of circulating immune complexes (CIC), showed that CIC levels were also significantly higher in active arthritis and in RV, but that there was no correlation between the CIC levels in individual patients and Ig production by their PBMC in vitro. This indicates that no direct relationship exists between the occurrence of high CIC levels in RA and the presence of a systemic B-cell hyperreactivity which had been suggested by the enhanced Ig production by PBMC.     

Comparative studies on immunoglobulins,complement component (C3), albumin,and immunoglobulin A-containing circulating immune complexes in serum and bile of patients with biliary obstruction

We measured the concentrations of IgA, IgG, IgM, secretory IgA, albumin, complement component (C3), and IgA-containing circulating immune complex (IgA-CIC) in the serum and bile of patients with biliary obstruction. The bile-to-serum (BS) ratio of the concentrations of albumin and IgG increased with the increase in total serum bilirubin. This indicates that the permeability from blood to bile increases with the degree of biliary obstruction, and the blood-bile barrier function breaks down. The BS ratios of IgA and IgM, which are selectively secreted into bile, did not show a significant correlation with total serum bilirubin. The index of the BS ratio to the BS ratio of albumin (BS/BS-Alb index) of IgA and IgM was significantly larger than that of IgG. This indicates that the selective transport of IgA and IgM into bile is present even in patients with obstructive jaundice. Since the BS/BS-Alb index of C3 is larger than that of IgG, and the SGOT correlated directly with the BS ratio of C3, some of the C3 in bile may come from damaged hepatocytes.     

Evidence that circulating immune complexes remove transfused platelets from the circulation

Fifteen recently diagnosed patients with acute leukemias admitted for induction chemotherapy were selected for study. When thrombocytopenic (venous platelet count <20 × 10⁹/1) these patients received prophylactic platelet transfusions. A total of 67 platelet transfusion therapies were administered and evaluated. Using the Raji cell radioimmunoassay, the serum concentrations of circulating immune complexes (CIC) were measured immediately before and 10–12 hr after each platelet transfusion. In 36 instances, elevated values of CIC were present in the recipient's pretransfusion samples, the corresponding posttrans-fusion values being significantly lower (P < 0.05). Furthermore, in those 36 instances the mean percentage for the posttransfusion platelet increment was significantly lower (P < 0.001) than in the remaining 31 instances in which normal pretransfusion values of CIC were measured. We conclude that CIC were an important factor in rapidly removing transfused platelets from the circulation, thereby, adversely affecting the benefit of platelet transfusions.     

Characterization of circulating immune complexes by nephelometry in acute leukaemia

Summary Circulating immune complexes were isolated from 15 patients with acute leukaemia and 13 healthy blood donors by PEG precipitation. These were analysed according to their IgG, IgM and C4 content by optical rate nephelometry. Immune complexes of leukaemic patients contained higher amounts of IgM as compared to those from normal subjects. The clinical relevance of IgM containing immune complexes in leukaemia is discussed.     

Characterization of circulating immune complexes by nephelometry in acute leukaemia

Summary Circulating immune complexes were isolated from 15 patients with acute leukaemia and 13 healthy blood donors by PEG precipitation. These were analysed according to their IgG, IgM and C4 content by optical rate nephelometry. Immune complexes of leukaemic patients contained higher amounts of IgM as compared to those from normal subjects. The clinical relevance of IgM containing immune complexes in leukaemia is discussed.     

循环免疫复合物与冠状动脉粥样硬化斑块的相关性研究

目的 探讨循环免疫复合物(CICs)与冠状动脉斑块特征的相关性.方法 56例急性冠脉综合征(ACS)患者,发病时取血,酶联免疫吸附法(ELISA)检测血浆中CICs和氧化低密度脂蛋白(ox-LDL)等,以及液相蛋白芯片结合流式细胞分析方法 测定几种血管因子;常规冠状动脉造影(CAG).并行血管内超声(IVUS)检测56个靶病变处动脉粥样斑块形态学及性质特征.分析急性心肌梗死(AMI)与不稳定性心绞痛(UA)患者、易损斑块与非易损斑块组、发生斑块破裂时CICs的改变;以及与斑块形态学指标及血管因子的相关性.结果 ClCs和各血管因子浓度在AMI组与UA组之间未见显著性差异(均P>0.05);斑块破裂与非斑块破裂者比较tics浓度有显著性差异(287±26比170±31 mg/L,P=0.018);易损斑块与非易损斑块两组CICs的比较结果 显示,两组之间均无统计学意义(238±29比253±29 mg/L,P=0.78).ACS患者CICs浓度与斑块形态学指标无统计学意义;除组织纤维蛋白溶酶原激活物(t-PA)以外,CICs与其他的动脉粥样硬化形成不同阶段的炎症因子间大部分存在显著相关性;CICs与ox-LDL之间呈明显正相关性(r=0.591,P=0.005).结论 CICs结合其他因素对于ACS患者冠脉斑块破裂和AMI有重要的诊断意义.     

Immunoglobulin isotype composition of circulating and intra-articular immune complexes in patients with inflammatory joint disease

Summary The immunoglobulin (Ig) heavy chain isotype composition of intra-articular and circulating immune complexes (ICs) were determined by a Raji cell flow cytometric assay in paired serum and synovial fluid samples from 15 patients with rheumatoid arthritis (RA) and 15 patients with other articular diseases (osteoarthritis, ankylosing spondylitis, gout, psoriatic arthritis, Reiter's discase). ICs were most prevalent in synovial fluid samples of patients with RA but were infrequently detected in serum and synovial fluid samples from the non-RA patients. ICs in patients with RA were heterogeneous both in the prevalence of Ig subclasses identified and in the distribution of the respective Ig isotypes within the complexes. Furthermore, differences were observed in the Ig isotype composition of ICs in paired serum and synovial fluid samples in dicating that circulating ICs may not always arise simply by spill-over from articular sites. The possible mechanisms for IC formation in RA are discussed with reference to four patients who displayed features of extra-articular disease.     

The role of circulating immune complexes in the pathogenesis of diabetes mellitus

Summary We have studied soluble immune complexes (IC) in the sera of both insulin-dependent and non-insulin-dependent diabetics by a variety of non-specific techniques and also by a method that detects specifically insulin-anti-insulin IC. Our screening studies, detailed in the first section of this work, showed that insulin-anti-insulin IC appear not to be the only type of IC present in diabetics. Non-specific screening tests gave practically identical percentages of positive results in insulin-dependent and non-insulin-dependent diabetics. However, the agreement between different screening tests was poor. We propose the use of ‘IC scores’ (numerical expressions of the general trend of several screening tests performed with one given serum sample) for the statistical analysis of correlations between the presence of soluble IC and clinical evidence of diabetic microangiopathy. As expected, the use of ‘scores’ minimized false positives or negatives and considerably enhanced statistical correlations between levels of IC and proteinuria, nephropathy, retinopathy, peripheral neuropathy, and peripheral vasculopathy. The second section of this report describes our isolation studies, which provided definitive proof for the existence of soluble insulin-anti-insulin IC and allowed us to carry out the first successful studies of the biological properties of soluble IC purified from the sera of diabetic patients, as detailed in the third section of this report. Such IC-induced platelet aggregation and activation whichin vivo could lead to the development of microvascular lesions could explain, at least in part, the abnormalities in platelet function seen in diabetics. Although the precise mechanisms by which soluble IC could induce pathological damage in diabetics have not been totally clarified, we have obtained sufficient evidence to prove that antigen-antibody complexes exist in diabetics, are associated with higher frequencies of complications, and have the capacity to interact with cells in a potentially pathogenic fashion. Publication No. 488 from the Department of Basic and Clinical Immunology and Microbiology, Medical University of South Carolina. Research supported in part by the Kroc Foundation and by the State of South Carolina Research Appropriations for 1978–79, 1979–80, 1980–81 and 1981–82.