肺炎衣原体慢性感染的特异性抗体检测及其与支气管哮喘的相关性分析

自 196 5年分离出第 1株肺炎衣原体 (CPn)以来 ,有关CPn的研究已日趋深入。新近研究发现 ,CPn感染在哮喘的发病中可能起一定作用。我们采用间接免疫荧光技术 ,对 41例支气管哮喘患者进行血清CPn特异性抗体检测 ,并与 70人健康献血员相对照 ,旨在探讨CPn感染与支气管哮喘的关系。现将结果报告如下。1　资料与方法1.1　研究对象　支气管哮喘组 :41例 ,为我院 2 0 0 2 - 0 5～2 0 0 2 - 12住院及门诊患者 ,男 2 3例 ,女 18例 ,平均年龄 39岁 (14～ 74岁 )。所有病例均符合中华医学会呼吸病学分会哮喘学组 2 0 0 2 - 11修订的支气管哮喘诊断…     

肺炎衣原体感染与支气管哮喘的研究

目的　探讨肺炎衣原体 (CP)与支气管哮喘的相关性。方法　选择哮喘发作期和缓解期各 31例 ,健康对照组 30例 ,采用金标斑点法检测血清 CP抗体 ,金标斑点法测定血清 Ig M、Ig G,聚合酶链反应检测痰中 CP-DNA。结果　哮喘发作期 CP感染率 35 .5 %明显高于哮喘缓解期和对照组 (P<0 .0 5。哮喘发作期和缓解期 CP感染率分别为 35 .5 %、6 .4 % ,高于对照组 (P <0 .0 5 ) ,同时 Ig M在哮喘发作期 (2 7.3% ) ,Ig G在哮喘缓解期 (36 .4 % )。CP- PCR- DNA测定哮喘发作期 ,缓解期 Ig M组分别为 2 2 .6 %、9.7%、对照组 3.3%。结论　 CP感染为哮喘急性加重的一个重要诱因 ,而且是哮喘反复发作的原因之一。     

血清IgG联合IL-5、维生素D检测在肺炎支原体感染合并支气管哮喘患儿中的应用研究

目的观察血清Ig G联合IL-5、维生素D检测在肺炎支原体感染合并支气管哮喘患儿中的应用效果。方法选取2014年3月-2016年5月医院诊治的肺炎支原体感染患儿90例,根据是否合并支气管哮喘分为肺炎支原体感染组(n=54)及合并支气管哮喘组(n=36)。选取同期入院健康体检的健康儿30例,设为对照组。采用酶联免疫法(ELISA)法检测血清Ig G、Ig M及Ig E水平;采用酶联免疫检测试剂盒检测人白介素-5(IL-5)水平;采用液相色谱串联质谱检测技术测定维生素D水平。结果合并支气管哮喘组患者血清Ig G、Ig M及Ig E水平,显著高于肺炎支原体感染组和对照组(P0.05);合并支气管哮喘组IL-5水平,显著高于肺炎支原体感染组和对照组(P0.05);合并支气管哮喘组维生素D水平,显著低于肺炎支原体感染组和对照组(P0.05);非条件Logistic多因素分析显示:肺炎支原体感染合并支气管哮喘发生率与血清Ig G联合IL-5、维生素D水平关系密切(P0.05)。结论肺炎支原体感染合并支气管哮喘患儿治疗过程中检测血清Ig G联合IL-5、维生素D效果理想,值得推广应用。     

微量免疫荧光标记法检测冠心病患者血清肺炎衣原体抗体

目的　测定冠心病患者的血清肺炎衣原体特异性抗体 ,探讨其临床价值。方法　应用间接微量免疫荧光标记法对 2 0 5例体检健康人群和 170例住院确诊的冠心病患者进行肺炎衣原体特异性抗体 Ig G、Ig M的检测。结果　体检健康人群 Ig G总阳性率 2 1.5 % ;均阴性 ;冠心病患者 Ig G总阳性率为 91.2 % ,Ig M阳性率为 5 % ,其中无症状型冠心病组、不稳定型心绞痛组及急性心肌梗死组肺炎衣原体总感染率分别为 96 .2 %、86 %、88.1% ,既往感染率分别为 76 .9%、6 2 .0 %、71.4 % ,急性感染率分别为 19.2 %、2 4 .0 %、16 .7%。总感染率、既往感染率及急性感染率冠心病组较健康人群组明显增高 (优势比分别为 4 .14、2 .88、19.2 4 ,95 %的可信区间分别为 3.18～ 5 .39、2 .2 1～ 3.74、2 .79～ 132 .6 7)。结论　微量免疫荧光标记法系目前冠心病患者血清检测肺炎衣原体特异性抗体 ,从而确定肺炎衣原体感染的一个敏感度高、特异性强 ,简单易行的方法之一。     

日本血吸虫病人群获得性免疫与再感染IV.治后9个月人群特异性抗体水平与再感染

目的　了解血吸虫病洲岛型流行区居民血清抗 AWA、重组 PMY和 Teg Ag的抗体亚类水平及其与居民再感染的关系。方法　 137例行 5 0 mg/ kg吡喹酮顿服。 7周后粪检 ,阳性者再次治疗 ,4周后经再次粪检证实为阴性。经 1个感染季节后再粪检并采血 ,用 EL ISA法检测抗 3种抗原的抗体亚类水平。结果　观察对象治前感染率 2 8.5 % ,治后再感染率 6 .6 % ;抗 AWA的 Ig G4和 Ig A峰值出现在 2 0～ 2 9岁 ,Ig E的峰值在 40～ 49岁 ,Ig G2 则在 2 0～ 2 9岁和 40～ 49岁 ,抗 AWA的 Ig E与 Ig G4的水平呈正相关 ;男性抗 AWA和 PMY的抗体亚类水平显著高于女性 ;感染状态不同的 4组中 ,再感染组抗 AWA的特异性总 Ig G和 Ig G4较其他 3组高。结论　特异性抗体水平与年龄之间没有明显关系 ;抗 AWA的 Ig G4可能在易感个体内起着一种封闭性抗体的作用 ;抗 AWA的 Ig E反应伴随着 Ig G4的反应。     

COPD急性加重期肺炎衣原体感染的临床分析

目的　了解肺炎衣原体急性感染在 COPD急性加重期患者中的发生率及其临床特点。方法　采用固相酶联免疫吸附试验 EL ISA法测定 96例 COPD急性加重期患者血清肺炎衣原体特异性抗体 Ig G及 Ig M,同时进行痰培养 ,急性肺炎衣原体感染者分别给予阿奇霉素及左氧氟沙星治疗。结果　 COPD患者急性肺炎衣原体感染率 2 5 .0 % ,临床表现较其他 COPD患者无明显特征性 (P>0 .0 5 )。COPD患者痰细菌阳性率 5 8.3%。左氧氟沙星对肺炎衣原体急性感染的 COPD患者疗效良好。结论　 COPD急性加重期患者中肺炎衣原体急性感染率高且混合感染率多见 ,合并肺炎衣原体急性感染的 COPD患者临床表现无明显特征性。对于怀疑合并肺炎衣原体感染的COPD患者 ,新喹诺酮类药物可用作早期经验性治疗的药物。     

冠心病患者HCMV抗体和HCMV-DNA的测定及其临床意义

目的　探讨人巨细胞病毒 (HCMV)感染与冠心病的关系及 HCMV感染可否作为冠心病的独立危险因子。方法　间接酶联免疫吸附试验 (ELISA)测定 HCMV- Ig G、HCMV- Ig M和 HCMV- Ig A抗体 ,聚合酶链反应 (PCR)测定 HCMV- DNA。结果　冠心病组的 HCMV- Ig G、Ig M、Ig A抗体阳性率、S/N值 (标本 450 nm吸光度值 /阴性对照 450 nm吸光度值 )和 HCMV- DNA阳性率均明显高于对照组 ,且这些指标不受血清胆固醇、甘油三酯水平及是否伴有高血压和 /或糖尿病的影响 (除 HCMV- Ig M抗体阳性率在是否伴有高血压和 /或糖尿病两组间比较 P<0 .0 5外 ,余均为 P>0 .0 5)。结论　 HCMV感染可能与冠心病有关 ,HCMV感染有可能作为冠心病的独立危险因子。     

肺炎支原体感染对小儿支气管哮喘急性发作及免疫功能的影响

目的探讨肺炎支原体(MP)感染对小儿支气管哮喘急性发作和免疫功能的影响。方法选择58例支气管哮喘患儿作为观察组,其中急性期25例和缓解期33例,平均(6.43±3.21)岁;另外收集普通感冒患儿35例作为对照组,平均(6.83±2.89)岁。分析比较观察组急性期、缓解期和对照组三者之间MP感染情况和免疫功能的变化的特征。结果 MP感染率在急性期均高于缓解期和对照组,有统计学差异(P0.01);哮喘急性期支原体抗体滴度1:320明显高于缓解期及对照组(P0.01)。MP感染率和抗体滴度在哮喘缓解期和对照组之间均无统计学差异(P0.05)。哮喘急性期患者外周血Ig E和嗜酸粒细胞均高于缓解期和对照组((P0.01);与缓解期及对照组比较,急性期外周血CD~+_4显著升高,而CD~+_8显著降低,有统计学差异(均P0.05)。结论 MP感染易导致支气哮喘急性发作,且与免疫功能状态失衡有关。     

慢性阻塞性肺疾病患者外周血单个核细胞对23价肺炎链球菌荚膜多糖疫苗的反应

目的研究体外条件下慢性阻塞性肺疾病(COPD)患者外周血单个核细胞(PBMC)对23价肺炎链球菌荚膜多糖疫苗(PPV23)的反应。方法研究对象分为成人COPD组、老年COPD组、健康成人组、健康老年组。分离外周血单个核细胞进行体外培养24 h后,设PPV23刺激干预组与对照组。观察PPV23刺激48 h后外周血单个核细胞培养上清液中抗肺炎链球菌荚膜多糖特异性抗体水平。结果PPV23干预前后,各组间抗肺炎链球菌荚膜多糖特异性免疫球蛋白(Ig)G、IgM抗体浓度无差异(P>0.05)。加PPV23干预后,干预组抗肺炎链球菌荚膜多糖特异性抗体特异性IgG、IgM抗体浓度较对照组明显升高(P<0.05)。结论老年COPD患者外PBMC对PPV23抗原的反应与正常成人无差别,支持COPD老年人和健康老年人常规使用PPV23免疫接种。     

支气管哮喘发病与HLA-DRB1等位基因关系的研究

目的　探讨山东汉族支气管哮喘 (简称哮喘 )人群中人类白细胞抗原 (HL A) - DRB1基因型的分布 ,明确与哮喘有关的 HL A- DRB1易感基因。方法　选取急性发作期哮喘患者 (哮喘组 ) 5 0例 ,健康献血员 (对照组 )6 0例。应用序列特异性引物聚合酶链反应 (PCR- SSP)方法检测其 HL A- DRB1等位基因。结果　哮喘组 HL A-DRB1* 130 1- 130 2基因频率显著高于对照组 (P<0 .0 1) ,相对危险度 (RR)为 4 .13;其他等位基因频率两组无显著性差异 (P>0 .0 5 )。结论　 HL A- DRB1* 130 1- 130 2基因与哮喘发病相关 ,是山东汉族哮喘人群的易感基因。     

Detection of Chlamydia pneumoniae on cytospin preparations from bronchoalveolar lavage in COPD patients and in lung tissue from advanced emphysema

Chronic obstructive pulmonary disease (COPD) is associated with smoking but other etiological factors contribute. Chlamydia pneumoniae is an obligate intracellular bacterium causing both acute and chronic respiratory tract infections. Studies have revealed an association between chronic C. pneumoniae infection and COPD, asthma and lung cancer but there have been difficulties detecting C. pneumoniae in the bronchial tree. Cytospin slides prepared from bronchoalveolar lavage (BAL) fluid from 14 patients with COPD, 10 healthy smokers (S) and 7 non smokers (NS) were analyzed with a fluorescein isothiocyanate labeled monoclonal antibody to C. pneumoniae. Lung tissue from 24 patients with advanced emphysema who had undergone lung volume reduction surgery (LVRS) was examined with immunohistochemistry for C. pneumoniae. Archived serum samples for detection of specific C. pneumoniae antibodies by microimmunofluorescence were available for 30 of the BAL subjects and 11 of LVRS patients. C. pneumoniae elementary body like structures were found in 29% of cytospin specimens from COPD patients, 14% of NS and 10% of HS. C. pneumoniae was detected in lung tissue in 8%. COPD patients had higher titres of IgG and IgA than NS and S. There was no association between occurrence of C. pneumoniae in BAL fluid and antibody titres. In conclusion, the assays used for detection of C. pneumoniae in lung tissue are feasible, and could be adapted in adequately powered studies to further confirm an association between C. pneumoniae infection and COPD.     

Serum IgA and secretory IgA levels in bronchial lavages from patients with a variety of respiratory diseases.

The secretory immunoglobulin A (IgA) system plays an important role in the protection of epithelial surfaces. The aim of this study was to evaluate whether the measurement of the primary airway Ig (sIgA) concentration in bronchial washings is clinically useful in patients with airway epithelial injury or inflammation. We measured serum IgA levels and sIgA concentrations in the bronchial lavages of patients with chronic bronchitis (n = 10), bronchiectasis (n = 15), lung cancer (n = 15) and in healthy control subjects (n = 10). Absolute sIgA levels of bronchial lavage fluids in the chronic bronchitis, bronchiectasis and lung cancer groups were higher than the controls, but there was no significant difference between the groups. sIgA/ml recovered bronchial fluid ratios were similar in the all groups. Standardisation of samples by means of albumin concentration ratios (sIgA/alb) showed that the bronchial lavages of the patients with lung cancer, chronic bronchitis and bronchiectasis were generally similar and demonstrated a significantly decreased sIgA/alb ratio compared to that of control subjects (p = 0.001, p < 0.05 and p < 0.05). sIgA/alb ratios in bronchial lavages recovered from involved lung of the patients with lung cancer and bronchiectasis were lower as compared to uninvolved lung (p < 0.001 and p < 0.05). There was no significant difference in serum IgA levels between all groups. As a result, although our findings seem partly to confirm the hypothesis that local bronchial IgA secretion is impaired in areas of bronchial epithelial injury or inflammation, we thought that sIgA would be useless as a marker of respiratory epithelial injury or inflammation in patients with chronic bronchitis, bronchiectasis and lung cancer.     

Chronic Chlamydia pneumoniae infection is a risk factor for the development of COPD

Smoking is the major risk factor for the development of Chronic Obstructive Pulmonary Disease (COPD), but epidemiological data suggest that other etiological factors may also be involved. Chlamydia pneumoniae (Cpn) is an established cause of acute and chronic upper and lower respiratory tract infections. Data obtained from in vitro and in vivo studies indicate that Cpn infection can be involved in the development of both small airways disease and emphysema, the two major components of COPD. The aim of this study was to investigate the possible association between chronic Cpn infection and COPD. The study population was comprised of 199 consecutive patients who underwent bronchoscopy due to longstanding airway symptoms and for whom spirometry and serum samples for serology were available. Acute and convalescent sera were analysed for specific IgG and IgA Cpn antibodies using microimmunofluorescence. Chronic Cpn infection, defined as persistent elevated titres of IgA > or = 1/64, was present in 85 patients. Chronic infection was associated with smoking and higher age, but no gender difference was observed. Thirty patients had COPD, defined as FEV1/FVC < 70% without any features of asthma. Patients with COPD were older than those without, and there was no association with gender in this group. A statistically significant association, remaining after correction for smoking, was observed between chronic Cpn infection and COPD, and there was a trend for decreasing lung function with increasing antibody titres. The results suggest that chronic Cpn infection may be an independent risk factor for the development of COPD.     

慢性阻塞性肺疾病患者肺炎衣原体感染的研究

目的 探讨肺炎衣原体感染与慢性阻塞性肺疾病（COPD）的相关性。方法 选择61例COPD急性加重期患者,35例COPD稳定期患者,26名正常对照者,采用微量免疫荧光法测定血清肺炎衣原体特异性抗体IgA,IgM,IgG,套式聚俣酶链反应检测痰中的肺炎衣原体DNA。结果 COPD急性加重期患者的急性肺炎衣原体的感染率为31．1％,明显高于COPD稳定期和且（P＜0．05）。COPD急性加重期组和稳定期组的慢性肺炎衣原体感染率分别为21．3％和31．4％,明显高于对照组（P均＜0．05）,同时IgA的几何平均滴度在COPD急性加重期中最高（20．5）,COPD稳定期组中次之（10．8）,对照组最低（3．6）,三组间差异有显著性（P＜0．05）。结论 急性肺炎衣原体感染为COPD急性加重的一个重要诊因,慢性肺炎衣原体感染可能参与COPD的发病机制。     

Serum CC-10 in inflammatory lung diseases

BACKGROUND: Although Clara cell secretory protein (CC-10) has been ascribed an anti-inflammatory role in lung diseases, its precise role remains unclear. OBJECTIVE: To further our understanding of the role of CC-10 in inflammatory lung diseases, CC-10 protein levels were measured. METHODS: Sera or bronchoalveolar lavage (BAL) fluids were collected from patients with different inflammatory lung diseases including bronchial asthma, chronic obstructive lung disease (COPD), sarcoidosis, idiopathic interstitial pneumonia (IIP), chronic eosinophilic pneumonia (CEP), pneumonia and lung cancer. Serum CC-10 concentrations were measured by enzyme-linked immunosorbent assay using urinary protein-1 antibody. Then, the relationships between CC-10 concentrations and lung diseases were investigated. Immunohistochemistry was performed using lung biopsy samples. RESULTS: Increased serum CC-10 levels were recognized in IIP patients, while CC-10 levels were decreased in bronchial asthma patients and CEP patients. Immunohistochemistry revealed an aberrant expression in areas of fibrosis in IIP patients. Serum CC-10 concentrations were not associated with severity among IIP, COPD, and sarcoidosis. In contrast, serum CC-10 concentrations were correlated with FEV(1)/FVC in bronchial asthma patients. CONCLUSIONS: Although the number of patients was quite limited, these data provide new insights into the role of CC-10 in lung diseases, and the possibility that the CC-10 concentration in serum could be a new marker indicating the severity of bronchial asthma.     

Chlamydophila pneumoniae infection status is dependent on the subtypes of asthma and allergy.

This study was undertaken to investigate the association of Chlamydophila pneumoniae infection (CPI) with asthma and allergy. One hundred forty-one patients with asthma aged 3-21 years, 125 healthy controls aged 3-21 years, and 62 allergic but nonasthmatic patients aged 4-20 years participated in this study. C. pneumoniae-specific antibodies were measured by ELISA. There were no significant differences in the percentage of patients positive for C. pneumoniae-specific antibodies between the three groups. Significantly more allergic asthmatic patients were positive for C. pneumoniae-specific IgA and IgA + IgG than nonallergic asthmatic patients, and this difference remained significant after adjustment for age and gender: adjusted odds ratio (OR) = 5.9 (1.7-26.2) and p = 0.01 for IgA, and OR = 5.2 (1.6-25.8) and p = 0.02 for IgA + IgG. The prevalence of the C. pneumoniae-specific IgA and the IgA + IgG positivity also was significantly lower in the nonallergic asthmatic group than in the allergic and control groups (p < 0.005). No food/drug-allergic patient was positive for C. pneumoniae-specific IgA, whereas 41.6% of the inhalative-allergic patients were positive for this antibody (p = 0.002). In our population CPI does not associate directly with asthma and allergy, but chronic or recurrent infection is associated with allergic asthma and inhalative allergy as opposed to nonallergic asthma and noninhalative allergy.     

COPD与肺癌发病的相关性

目的：研究COPD与肺癌发病的相关性。方法收集2010年11月至2013年11月我院收治的门诊或住院患者210例肺癌患者作为实验组,同时选取在玉林市红十字会医院体检中心体检的非癌健康人226例作为对照组,观察2组研究对象个人呼吸系统疾病史、家族呼吸系统疾病史与肺癌之间的关系,同时观察2组中吸烟患者和不吸烟患者的 COPD 发生率。结果呼吸系统疾病中肺炎、哮喘与肺癌的发生无显著关系(P 值均>0.05)；伴有 COPD、支气管炎、肺气肿、肺结核的患者,发生肺癌的风险显著增高(P 值均<0.05),其中 COPD 与肺癌发生的关联性最强(OR =2.73)。具有COPD及肺癌家族史的人群,发生肺癌的风险显著增加(P<0.05)。吸烟患者中实验组COPD的发生率显著高于对照组(χ2=5.482,P<0.05)；实验组未吸烟患者中实验组 COPD的发生率显著高于对照组(χ2=5.901,P<0.05)。结论患有COPD病史及有 COPD家族史的患者,发生肺癌的风险增加,且COPD患者无论是否吸烟,COPD仍然会导致肺癌发生的风险性增加。     

支气管哮喘和COPD患者血清IL-10水平的临床研究

目的 探讨血清IL-10在哮喘和COPD炎症机制中的作用.方法 选对照组50例、哮喘急性发作期及缓解期组各50例、COPD急性加重期(AECOPD)及COPD稳定期组各50例.用ELISA法测定血清IL-10水平,统计学分析.结果 哮喘急性发作期IL-10水平低于缓解期,P＜0.05,且两组均低于对照组,P＜0.05.AECOPD IL-10水平低于稳定期,P＜0.05,且两组均低于对照组,P＜0.05.哮喘急性发作期IL-10水平低于AECOPD,P＜0.05.哮喘缓解期IL-10水平低于COPD稳定期,P＜0.05.结论 IL-10是参与哮喘和COPD发病的重要因子;血清IL-10水平的变化作为哮喘和COPD疾病分期的判断指标;对哮喘和COPD的鉴别有临床意义.     

Serum immunoglobulins predict the extent of hepatic fibrosis in patients with chronic hepatitis C virus infection

Recently, we documented that immunoglobulins stimulate the proliferative activity of rat hepatic stellate cells in vitro. The aim of the present study was to determine whether there is any association between serum immunoglobulin levels and hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection. Charts from 116 patients with biochemical, serologic, virologic and histologic evidence of chronic hepatitis C infection and serum immunoglobulin levels (IgA, IgG, IgM and total) were reviewed. The mean (+/-SD) age of the study population was 46 +/- 11 years and 67 (58%) were male. There were significant correlations between serum IgA (r = 0.39, P = 0.00001), IgG (r = 0.49, P = 0.000002) and total (r = 0.51, P = 0.000003) immunoglobulin levels and the stage of hepatic fibrosis. When serum immunoglobulin levels were included into logistic regression analysis with variables known to be associated with advanced disease (male gender, age >40 years at onset of infection, duration of infection beyond 20 years and concurrent alcohol abuse) only IgA, IgG and total immunoglobulin levels (P < 0.05, <0.05 and <0.005, respectively) emerged as independent predictors of hepatic fibrosis. Our data indicate a strong association between serum immunoglobulin levels (IgA, IgG and total) and hepatic fibrosis in patients with HCV infection. This finding supports the need to further investigate whether immunoglobulins independently promote disease progression in patients with chronic HCV infection.     

肺炎衣原体感染与慢性阻塞性肺疾病关系的研究

目的　探讨肺炎衣原体感染在慢性阻塞性肺疾病 (COPD)发病中的作用。方法　实验分 2部分 ,(1)动物实验 :雄性Wistar大鼠 4 0只 ,分为A、B、C、D组 ,每组 10只 ,除D组外分别予香烟烟雾吸入和 (或 )经气管滴入肺炎衣原体菌液。 6周后测肺功能 ,行肺部病变病理评分及PCR检测肺部肺炎衣原体感染情况。 (2 )临床研究 :用PCR测COPD患者 (17例 )及健康对照者 (19例 )肺脏肺炎衣原体DNA ,同时测血清肺炎衣原体IgG及IgA抗体。结果　 (1)B组和C组大鼠肺组织肺炎衣原体DNAPCR阳性率分别为 88 9%和 80 0 %。B组大鼠肺组织病理改变主要为炎性细胞浸润及小气道平滑肌增生 ,病理及肺功能改变均较A组显著 ;C组主要病理改变为气道壁炎性细胞浸润及平滑肌增生较明显 ,与D组比较差异有显著性 ,肺功能与D组比较无明显差异。 (2 )COPD患者血清IgG抗体阳性率为 82 4 % ,IgA为 5 8 8% ,均明显高于健康对照者 (P值均 <0 0 5 ) ;PCR检测患者肺组织肺炎衣原体DNA均为阴性。结论　肺炎衣原体感染与COPD无直接关系 ,即单纯肺炎衣原体感染不能引起COPD的发病 ,但它可在吸烟所致病变的基础上加重COPD的病理改变及气流阻塞。