联合抗过敏疗法对急性乙型肝炎病人的疗效和血清内IgE及组织含量的动态观察

为探讨IgE及其介导的I型变态反应在急性乙型肝炎发病机理中的作用,对42例急性乙型肝炎病人随机分为治疗组和对照组,并观察了联合抗过敏疗法对急性乙型肝炎的疗效和血清内:IgE水平及组织胺含量的动态变化.结果发现,治疗组行联合抗过敏疗法后血清内丙氨酸转氨酶(ALT)和总胆红素(T-BIL)均比治疗前明显降低(P＜0.01),而对照组治疗前后无明显变化;治疗组ALT及T-BIL复常天数明显少于对照组(P＜0.01,P＜0.05);无论是对照组或治疗组,治疗前血清内IgE水平和组织胺含量均显著高于正常人(P＜0.01);治疗组治疗后IgE水平明显低于治疗前(P＜0.01);对照组无显著性差异(P＜0.05);治疗组治疗后组织胺水平无显著差异,但对照组治疗后组织胺明显高于治疗前(P＜0.05).提示,IgE及其介导的I型变态反应与急性乙型肝炎的发病机理有一定关系,而且通过联合抗过敏疗法得到进一步证实.     

老年慢性鼻-鼻窦炎及伴鼻息肉患者并发支气管哮喘和肺功能下降相关性

目的探讨慢性鼻-鼻窦炎与老年支气管哮喘的相关性。方法慢性鼻-鼻窦炎的患者70例分为单纯性慢性鼻-鼻窦炎(A组,n=31)和慢性鼻-鼻窦炎伴鼻息肉(B组,n=39)两组,观察不同分期慢性鼻-鼻窦炎患者的支气管哮喘和变应性鼻炎的发病率、不同分期慢性鼻-鼻窦炎合并哮喘患者的肺功能、不同分级慢性鼻-鼻窦炎合并鼻息肉患者的支气管哮喘和变应性鼻炎的发病率、有哮喘的不同分级慢性鼻-鼻窦炎合并鼻息肉患者的肺功能、两组患者与合并哮喘患者的鼻内镜、鼻窦CT和症状的评分。结果 A组病程明显低于B组(P=0.009);单纯性慢性鼻-鼻窦炎Ⅰ、Ⅱ和Ⅲ期患者并发支气管哮喘的概率有显著差异(P=0.031);8例慢性鼻-鼻窦炎合并哮喘患者的各分期肺功能有显著差异(P=0.028);单纯鼻窦炎合并哮喘患者的症状评分明显高于单纯鼻窦炎患者(P<0.01)。鼻息肉合并哮喘患者的症状评分明显高于鼻息肉患者(P<0.01)。结论单纯性慢性鼻-鼻窦炎与老年患者支气管哮喘发病率及肺功能下降密切相关,鼻窦炎老年患者合并支气管哮喘能够显著增加临床症状。     

鼻窦内镜术辅助盐酸氨溴索治疗老年慢性鼻窦炎伴鼻息肉的疗效及对血清IL-6、IL-17、IL-23表达的影响

目的探究鼻窦内镜术辅助盐酸氨溴索治疗老年慢性鼻窦炎伴鼻息肉的疗效及对血清白细胞介素(IL)-6、IL-17、IL-23表达的影响。方法 62例老年慢性鼻窦炎伴鼻息肉患者随机分为观察组与对照组各31例。对照组接受Messerklinger术式行鼻窦内镜手术,在此基础上,观察组予以盐酸氨溴索经鼻超声雾化吸入治疗。比较两组疗效,采用Lund-Mackay评分评价鼻内镜及鼻窦CT检查结果,视觉模拟评分(VAS)评价主观症状严重程度,鼻腔鼻窦结局测试(SNOT)-20评分量表评估生活质量;同时测定鼻黏膜纤毛传输速率、鼻腔容积(NCV)、鼻腔的最小横截面积(NMCA)、鼻腔最小横截面至前鼻孔距离(DCAN)及血清IL-6、IL-17、IL-23水平。结果观察组总有效率明显高于对照组(P0.05);观察组治疗后VAS、SNOT-20、Lund-Mackay评分均明显低于对照组(P0.001);观察组IL-6、IL-17、IL-23水平均明显低于对照组(P0.001);观察组NCV、NMCA、鼻黏膜纤毛传输速率均明显高于对照组(P0.001),而DCAN明显低于对照组(P0.05)。结论鼻窦内镜术辅助盐酸氨溴索治疗老年慢性鼻窦炎伴鼻息肉疗效确切,可有效减轻相关症状体征,促进鼻腔功能恢复,加快鼻黏膜纤毛传输速率,提高日常生活质量,这可能与血清IL-6、IL-17、IL-23表达降低有关。     

白细胞介素13基因-1112C/T多态性与支气管哮喘患者发病及血浆总IgE水平的相关性

目的探讨白细胞介素13(IL13)基因启动子区-1112C/T多态性与支气管哮喘(简称哮喘)的相关性及对血浆总IgE水平的影响。方法将哮喘患者(100例)和健康人(100名)被分为哮喘组和对照组,用聚合酶链反应限制性片段长度多态性(PCRRFLP)方法检测哮喘组与对照组-1112位点多态性,用酶联免疫吸附法(ELISA)测定血浆总IgE水平。结果-1112位点等位基因C、T频率在两组间分布的差异具有显著性(χ2=901,P<001),等位基因T与哮喘关联[OR(T/C)=203,95%CI=127～323,P<001]。两组基因型(TT、CT、CC)频率的分布比较差异有显著性(χ2=719,P<005),其优势比OR(TT/CC)=299,95%CI=106～841(P<005);OR(CT/CC)=204,95%CI=109～381(P<005);OR(TT/CT)=146,95%CI=049～437(P>005);在哮喘组CC、CT及TT基因型患者的血浆总IgE水平分别为(204±89)kU/L、(320±108)kU/L、(376±147)kU/L,而在对照组CC、CT及TT基因型患者的血浆总IgE水平分别为(96±34)kU/L、(122±42)kU/L、(150±36)kU/L。同组内T等位基因携带者血浆总IgE水平高于非携带者;同一基因型中哮喘组总IgE水平高于对照组。结论IL13基因-1112位点多态性是影响哮喘的重要候选基因,T等位基因与哮喘关联,并可能通过增强IL13基因的表达影响血浆总IgE水平。     

呼吸道症状特应症患者尘螨过敏状态与呼出气一氧化氮和血清IgE的关系

目的:探讨呼吸道症状特应症患者尘螨过敏状态、呼出气一氧化氮(FeNO)和血清免疫球蛋白E(IgE)三者之间的关系。方法:选取2016年1月至12月在我院变态反应(过敏)科门诊就诊的呼吸道症状特应症患者129例,分别进行过敏原皮肤点刺试验(SPT)及FeNO测定;其中51例同时进行血清总IgE、户尘螨特异性IgE(sIgE)、粉尘螨sIgE测定。结果:129例患者中户/粉尘螨阳性组FeNO值明显高于阴性组(P0.05)。51例同时进行血清总IgE、户尘螨sIgE、粉尘螨sIgE检测的患者中,户/粉尘螨阳性组的血清总IgE、sIgE分别高于阴性组(P0.05);FeNO升高组的血清总IgE、户尘螨sIgE、粉尘螨sIgE分别较FeNO正常组高(均P0.01),且FeNO值与血清总IgE呈正相关(r=0.376,P0.01)。结论:呼吸道症状特应症患者以户/粉尘螨过敏为主,FeNO值可在一定程度上反映过敏状态;而FeNO与血清总IgE和sIgE之间的紧密联系,值得进一步探讨。     

类几丁质酶YKL-40及Toll样受体4在慢性鼻窦炎伴鼻息肉与不伴鼻息肉患者中的表达差异

目的探讨类几丁质酶YKL-40及Toll样受体(TLR)4在慢性鼻窦炎伴鼻息肉与不伴鼻息肉患者中的表达差异。方法慢性鼻窦炎伴鼻息肉老年患者19例、不伴鼻息肉老年患者21例为研究组,取其窦口鼻道复合体黏膜;同期鼻中隔偏曲老年患者20例为对照组,取其下鼻甲黏膜。采用RT-PCR法检测各组标本中YKL-40、TLR4及核因子(NF)-κB mRNA表达情况;免疫组化法检测标本中YKL-40、TLR4蛋白表达强度。结果mRNA水平:伴鼻息肉组和不伴鼻息肉组类几丁质酶YKL-40 mRNA表达均明显高于对照组(P0.05);伴鼻息肉组和不伴鼻息肉组TLR4、NF-κB mRNA表达均明显低于对照组(P0.05)。不伴鼻息肉组YKL-40、TLR4之间无相关性(r=0.087,P0.05);伴鼻息肉组YKL-40与TLR4呈负相关(r=-0.852,P0.05)。蛋白质水平:YKL-40在伴鼻息肉组的表达程度明显高于不伴鼻息肉组(P0.01);不伴鼻息肉组与对照组YKL-40表达程度之间差异无统计学意义(P0.05)。TLR4在伴鼻息肉组和不伴鼻息肉组表达均明显低于对照组(P0.01);伴鼻息肉组与不伴鼻息肉组TLR4表达程度之间无统计学差异(P0.05)。伴鼻息肉组YKL-40与TLR4蛋白质表达呈负相关(r=-0.571,P0.05);不伴鼻息肉组YKL-40与TLR4蛋白质表达无相关性(r=-0.251,P0.05)。结论类几丁质酶YKL-40在慢性鼻窦炎伴鼻息肉组织中高表达,且与TLR4呈负相关,提示二者存在交互作用,同时参与了慢性鼻窦炎伴鼻息肉的发生、发展。     

冠心病患者外周血总IgE水平的变化

目的 评估不同类型冠心病（CHD）患者外周血中总免疫球蛋白E（IgE）的水平变化意义。方法 选取CHD患者56例:急性心肌梗死（AMI）患者22例,不稳定型心绞痛（UA）患者17例以及17例稳定型心绞痛（SA）患者。对照组为年龄匹配的健康个体。所有受试者均无家族及个人过敏史。采用ELISA法测定血清总IgE的水平。结果 与对照组［IgE水平(52±30)kU/L］相比,不同类型CHD患者血清总IgE的水平［AMI组:(179±159)kU/L,P<0.01;UA组:(131±78)kU/L,P<0.05;SA组:(127±65)kU/L,P<0.05］均明显增高。AMI患者发病后1,7,14,30 d血清总IgE的水平没有显著差异。结论 各种类型冠心病患者外周血总IgE的水平均升高。     

肠易激综合征患者食物变应原特异性IgE和IgG检测结果分析

目的探讨肠易激综合征食物过敏反应类型,对患者进行饮食指导。方法对64例肠易激综合征患者（观察组）和30例健康人（对照组）行食物特异性IgG和IgE检测。结果观察组特异性IgG检测阳性率明显高于对照组,P〈0.01;特异性IgE阳性率与对照组比较无显著性差异。特异性IgG检测阳性率由高到低依次为鸡蛋、花生、小麦、牛奶、大豆、大米、虾。结论食物过敏是肠易激综合征发病的一个重要因素,在食物过敏导致变态反应中由IgG介导的变态反应占主要地位,而由IgE介导的变态反应占次要地位。特异性IgG检测可用于指导肠易激综合征患者的饮食,有助于肠易激综合征的临床治疗。     

哮喘和慢阻肺重叠综合征患者血清总IgE水平改变及其临床意义研究

目的哮喘和慢性阻塞性肺疾病重叠综合征(SAC)患者血清总IgE水平改变及其临床意义研究。方法连续性收录28例哮喘患者,40例慢阻肺患者和22例SAC患者,综合分析比较三组患者肺功能情况和血清总IgE水平差异。结果慢阻肺组和SAC组患者FEV1%pred水平明显低于哮喘组(P0.05)。哮喘组和SAC组患者吸入支气管舒张剂后FEV1改善值明显高于慢阻肺组(P0.05)。慢阻肺患者血清总IgE水平明显低于哮喘组和SAC组患者(P0.05),而哮喘组明显高于SAC组(P0.05)。通过Pearson相关性分析可见三组患者血清总IgE水平均与吸烟指数呈负相关(P0.05)。而SAC组患者可见血清总IgE水平与FEV1改善值呈负相关(P0.05)。血清总IgE的AUC为0.577,95%CI为0.505~0.624。结论 SAC患者血清总IgE水平明显高于慢阻肺组,而低于哮喘组,血清总IgE水平对于SAC的诊断价值较低。     

系统性红斑狼疮患者血清IgE水平及其与疾病活动性的关系

目的评估系统性红斑狼疮(systemic lupus erythematosus, SLE)患者血清总IgE水平,并探讨其与SLE患者临床特征、实验室指标和疾病活动度的关系。方法检测SLE患者、健康对照和过敏性疾病患者血清总IgE水平。评估SLE患者临床症状和组织受累情况,采用SLE疾病活动度指数(SLE disease activity index 2000, SLEDAI 2K)评估疾病活动度。结果 SLE患者血清总IgE(中位数44.2 U/ml,范围1.82～2 630 U/ml)高于健康对照者(中位数35.65 U/ml,范围4.66～1 130 U/ml,P=0.028),但低于过敏患者(中位数350.6 U/ml,范围72.16～2 851 U/ml,P0.001)。SLE患者中活动期患者总IgE(中位数208 U/ml,范围8.18～2 510 U/ml)显著高于静止期患者(中位数26.05 U/ml,范围1.82～2 630 U/ml,P0.001);总IgE水平与SLE疾病活动度相关(r=0.51,P0.001)。SLE患者IgE水平升高与是否合并过敏性疾病无关。结论 SLE患者血清IgE水平升高,其升高与疾病活动度相关,与是否合并过敏性疾病无关。IgE可能在SLE发病中,尤其疾病活动阶段发挥免疫调节作用。     

IgE myelomatosis

Summary This paper describes a case of IgE (kappa) myeloma in a 39 year old female patient who has been observed for a period of eight years to the present. The findings and the course of disease in this patient were compared with 18 other case reports published since the discovery of IgE in 1966. In contrast to myelomas of other immunoglobulin classes, patients with IgE myelomas are somewhat younger and anaemia and hyperproteinaemia are more pronounced. A plasma cell leukaemia is more frequent and the ratio of light chains has shifted in favour of the kappa chains.     

Environment and serum IgE

Immunobiological diagnosis of allergy by measurement of total and specific IgE (by the technique of the CAP System on UNICAP) remains very valuable, especially if it is possible to repeat the measurements to follow the development of the patient. Concerning an observation of one patient who presented a rhinotracheitis that developed over 10 years and was linked clinically to guinea pig hair, the measurement of total and specific IgE confirmed the diagnosis and favourable clinical development was corroborated by the significant parallel diminution of total and specific IgE.     

Mechanisms of IgE Inflammation

The prevalence of diseases such as allergic asthma and rhinitis continues to increase in the United States, affecting millions of people. It is well-established that allergy contributes to the pathogenesis of most asthma, especially in children and young adults. Despite current therapy (eg, inhaled corticosteroids, anti-leukotrienes, and bronchodilators), patients with moderate to severe asthma remain symptomatic and experience frequent exacerbations of disease requiring oral corticosteroids, emergency department treatments, and hospitalizations. Allergic diseases are traditionally referred to as immediate or type 1 hypersensitivity reactions, with IgE as a critical factor. IgE is involved in allergic inflammation, especially in early-phase response, but it may also be involved in the late-phase allergic response. A direct correlation between serum IgE levels and asthma exists. As logarithm IgE values increase, asthma prevalence increases linearly, even in patients who are categorized as having nonallergic asthma. In addition, there is a significant, although low association in allergic rhinitis with IgE levels and positive skin test reactivity to pollens. Recent advances in our understanding of the role of IgE in allergic inflammation have led to the development of a monoclonal antibody to IgE that reduces IgE levels, thereby reducing allergic inflammation. This review aims to provide an overview of the basic science of the IgE molecule and the clinical efficacy of anti-IgE therapy in allergic and asthmatic diseases.     

Inhibition of IgE synthesis by anti-IgE: role in long-term inhibition of IgE synthesis by neonatally administered soluble IgE.

Inoculation of syngeneic IgE into 2- to 12-day-old mice results in prolonged synthesis of anti-IgE antibodies without further challenge. These anti-IgE antibodies may be largely responsible for the long-term inhibition of synthesis of IgE that is known to result from a perinatal challenge with IgE. This conclusion is supported by the effect of passive inoculation of syngeneic polyclonal anti-IgE antibodies into young mice, which similarly results in selective inhibition of IgE synthesis. Further evidence is the close relationship between the age dependency of IgE-induced inhibition of subsequent IgE synthesis and the ability of IgE to induce anti-IgE antibodies. IgE synthesis was monitored at the level of secretion by B cells as well as serum IgE levels and IgE antibody responses.     

Anti-insulin IgE in diabetics

Anti-insulin IgE and IgG were estimated in sera of diabetic patients. Using a paper radioimmunosorbent technique, detectable titers of anti-insulin IgE were found in all insulin-treated diabetics who were non-allergic to insulin. Patients with generalized insulin allergy, and immune-type insulin-resistance had higher titers of anti-insulin IgE. Anti-insulin IgG was present in all insulin-treated patients. The titers were significantly higher in insulin-resistant diabetics. Four of the 12 cases with insulin allergy had undetectable anti-insulin IgG titers. The ratios of 125I-insulin bound by IgE and IgG were significantly higher in 11 (91%) patients with systemic insulin-allergy. It is suggested that a relative excess of anti-insulin IgE may be associated with the insulin allergic state.