Decreased vitamin A levels in common variable immunodeficiency: vitamin A supplementation in vivo enhances immunoglobulin production and downregulates inflammatory responses

BACKGROUND: Vitamin A has a broad range of immunological effects, and vitamin A deficiency is associated with recurrent infections. Common variable immunodeficiency (CVI) is a group of B-cell deficiency syndromes with impaired antibody production and recurrent bacterial infections as the major manifestations, but the immunological dysfunctions may also include T cells and macrophages. In the present study we examined the possible role of vitamin A deficiency in CVI. PATIENTS AND METHODS: We analysed plasma vitamin A levels in 20 CVI patients and 16 controls, and examined the relationships between vitamin A and clinical, immunological and metabolic parameters in CVI. In the six CVI patients with the lowest vitamin A levels we also studied the effect of vitamin A supplementation in vivo on several immunological functions in these patients. RESULTS: (i) The majority of CVI patients had decreased vitamin A levels compared with healthy controls, as found in both cross-sectional and longitudinal testing. (ii) Low vitamin A levels were associated with the occurrence of chronic bacterial infections and splenomegaly as well as high neopterin levels. Decreased levels of carrier protein and malabsorption were not observed. (iii) Vitamin A supplementation in patients with low vitamin A levels resulted in increased interleukin-10 (IL-10) and decreased tumour necrosis factor-alpha (TNFalpha) levels, as found in both plasma and monocyte supernatants, possibly favouring anti-inflammatory net effects. (iv) Vitamin A supplementation in vivo also enhanced anti-CD40-stimulated IgG production, serum IgA levels and phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear cell (PBMC) proliferation. CONCLUSION: A considerable subgroup of CVI patients appears to be characterized by low vitamin A levels. Our findings support a possible role for vitamin A supplementation in CVI, perhaps resulting in enhanced immunoglobulin synthesis and downregulated inflammatory responses.     

鼻咽癌患者外周血淋巴细胞中EB病毒DNA载量与临床分期的关系研究

目的检测鼻咽癌患者外周血淋巴细胞中EB病毒DNA载量．并分析其与鼻咽癌临床分期的关系。方法选取2012年1月至2013年1月我院肿瘤科收治住院的87例鼻咽癌患者．采用实时荧光定量PCR法检测外周血淋巴细胞EB病毒DNA含量;统计学分析其与患者临床分期的关系。结果鼻咽癌患者外周血淋巴细胞中EB病毒DNA检出率为82．76％（72／87）,EB病毒DNA拷贝数的中位数为7．58×106拷贝数／ml,I、Ⅱ、Ⅲ和Ⅳ期患者每毫升DNA拷贝数分别为f4．25±1．141x10^3、（4．56±0．68）×10^4、（7．88±1．65）×10^5和（8．09±1．65）x106;EB病毒DNA载量随着疾病临床分期的增加呈现逐步升高的趋势。且差异显著（P〈0．05）。结论鼻咽癌患者外周血淋巴细胞中EB病毒DNA载量与患者临床分期相关．提示EB病毒DNA载量与鼻咽癌病情进展关系密切．在临床上可作为鼻咽癌患者病情监测及判断疗效的一种有效手段。     

轮状病毒肠炎患儿异型淋巴细胞和免疫球蛋白水平的变化分析

目的探讨轮状病毒（RV）肠炎患儿异型淋巴细胞数量及免疫球蛋白水平治疗前后变化的临床意义。方法分别检测50例RV肠炎患儿（肠炎患儿组）及30例健康小儿（健康对照组）治疗前后的血常规和异型淋巴细胞数量及血清免疫球蛋白水平。结果治疗前RV肠炎患儿组外周血异型淋巴细胞明显高于健康对照组（P〈0.01）,RV肠炎患儿血清免疫球蛋白IgA、IgM和IgG水平下降。治疗后RV肠炎患儿组外周血异型淋巴细胞低于治疗前（P〈0.05）,血清免疫球蛋白IgA、IgM和IgG水平上升甚至接近正常水平。结论 RV肠炎患儿治疗前后进行异型淋巴细胞数量及免疫球蛋白水平的检测有助于对病毒感染的判断及了解患儿的机体免疫功能状态和对疾病治疗的有效性,对RV肠炎患儿的治疗有指导意义。     

乙型肝炎免疫球蛋白阻断乙型肝炎病毒宫内感染的临床研究

目的:评估妊娠晚期使用乙型肝炎免疫球蛋白(hepatitis B immunoglobulin,HBIG)阻断乙型肝炎病毒(hepatitis B virus,HBV)宫内感染的疗效.方法:112例血清HBsAg阳性孕妇随机分为两组:HBIG组57例,于孕28周起肌内注射HBIG,200U,每4周1次,至分娩;对照组55例,未予用药.两组孕妇均于孕28周和分娩前,其新生儿于出生时检测外周血乙型肝炎病毒脱氧核糖核酸(hepatitisB virus deoxyribonucleic acid,HBV DNA)水平及肝炎血清标志物.结果:HBIG组和对照组宫内感染率分别为11%和27%,差异有统计学意义(P＜0.05).宫内感染率随孕晚期母血HBV DNA含量增加呈增高趋势.结论:孕妇产前多次注射HBIG可有效降低HBV宫内感染率,母血HBV DNA等于或超过108拷贝/毫升者宫内感染可能性增大.     

Abnormalities of in vitro responses to polyclonal activation of peripheral blood lymphocytes in patients with active sarcoïdosis

Abstract. A variety of immunological abnormalities have been described in patients with sarcoïdosis. At the blood level, both hypo and hyper immune responsiveness seem to coexist and were related to abnormal T cell and macrophage functions by using allogenic cocultures and/or lymphocyte fractionation. We tested several components of cell mediated responses with two in vitro models: (a) the pokeweed mitogen activation of B cells which is T cells and macrophage dependent; (b) the Epstein-Barr virus (EBV) activation of B cells which is T cell- and macrophage-indepen-dent. We confirm previous data showing that PWM induced Ig Production of peripheral blood lymphocytes (PBL) of patients with sarcoïdosis is significantly reduced compared with normal PBL. However, this is associated with an increase of IgG, IgM synthesis of EBV-infected PBL in these sixteen patients. Thus, there is no evidence for a complete B cell defect in sarcoïd PBL. Furthermore, by using limiting dilution analysis of antibody secreting cells, there is an increase of precursor B cells EBV infectable in PBL of sarcoïd patients but T cells are effective in reducing EBV-induced B cell proliferation. Finally, these abnormalities are concomitant to the disease, disappear with it, and are apparently not correlated with the stage or the activity of sarcoïdosis.     

实时荧光定量聚合酶链反应测定葡萄膜炎患者血浆EB病毒DNA的实验研究

目的：探讨EB病毒感染在葡萄膜炎发病机制中的作用。方法：采用实时荧光定量PCR（FQ—PCR）检测葡萄膜炎患者（Vogt-Kayanagi—Harada综合征26例,Behcet’s病21例,特发性全葡萄膜炎11例,急性前葡萄膜炎7例,中间葡萄膜炎3例,交感性眼炎2例）和健康对照组（30例）外周血EB病毒DNA,并进行比较。结果：26例Vogt—Kayanagi—Harada综合征患者中有6例检测到EB病毒DNA,阳性率为23％,其他类型的葡萄膜炎患者及健康对照组外周血均未检测到EB病毒DNA。结论：EB病毒感染或潜伏感染再激活可能与Vogt-Kayanagi—Harada综合征的发病有关。     

Transient lymphadenopathy during intravenous immunoglobulin (IVIg) in a patient with pemphigus vulgaris

This is the first case of transient cervical lymphadenopathy as an adverse event during IVIg infusion. IVIg plays a vital role in the treatment of many dermatological conditions and identification of adverse events can facilitate patient counseling.     

Specific anti-influenza virus antibody production in vitro by lymphocytes from a subset of patients with hypogammaglobulinemia.

Specific anti-influenza virus antibody production in vitro was studied in peripheral blood mononuclear cells from 17 patients with hypogammaglobulinemia. Cells obtained from 6 of 12 patients with common variable hypogammaglobulinemia produced anti-influenza virus antibody, predominantly of the IgM isotype, when cultured in vitro with type A influenza virus. No antibody was produced in vitro, however, by cells from either of two patients with Bruton's type X-linked hypogammaglobulinemia or by cells from any of three patients with X-linked hypogammaglobulinemia and isolated growth hormone deficiency. These studies demonstrate that peripheral blood mononuclear cells from a subset of patients with common variable hypogammaglobulinemia retain the potential to produce specific antibody in response to antigenic stimulation.     

Decreased production of and response to interleukin-2 by cultured lymphocytes from patients with systemic lupus erythematosus.

We studied the production of and response to interleukin-2 (IL-2) by peripheral blood T lymphocytes from 19 systemic lupus erythematosus (SLE) patients who received no treatment at the time they were studied. Eight had active disease and the rest were in remission. Results were compared with those obtained in 12 healthy subjects of similar age. T cells from SLE patients, whether activated with phytohemagglutinin or in autologous mixed lymphocyte reactions, were found to yield little IL-2, to have a low response to IL-2 from its own, or other sources, and to absorb IL-2 poorly, IL-2 produced by SLE cells, albeit scant, was absorbed normally by activated T cells from normal subjects. Our findings may contribute to the understanding of the immunoregulatory defect in SLE.     

EB病毒DNA定量检测在鼻咽癌临床分期中的诊断价值

目的探讨EB病毒(EBV)DNA定量检测在鼻咽癌患者不同临床分期中的诊断价值。方法选取广东省汕头大学医学院附属粤北人民医院2013年3月至2015年12月500例病理诊断为鼻咽癌的患者作为研究组,同时选取200例健康体检人群作为对照组。2组同时采用荧光定量聚合酶链式反应(PCR)方法检测血浆EBV-DNA的表达量,并对2组之间及临床TNM分期I、Ⅱ与Ⅲ、Ⅳ的结果进行比较;再将其分别与酶联免疫吸附测定(ELISA)方法检测的血清EBV病毒壳抗原免疫球蛋白A(VCA-IgA)检测结果进行比较。结果荧光定量PCR方法检测EBV-DNA表达量中,研究组阳性率75.00%,对照组阳性率9.00%,两者差异有统计学意义(P0.05)。鼻咽癌患者血浆EBV-DNA拷贝数与临床TNM分期呈正相关,差异有统计学意义(P0.05);鼻咽癌分期越晚,血浆EBV-DNA拷贝数越高。结论血浆EBV-DNA水平与鼻咽癌患者临床TNM分期有显著相关性,可作为评估鼻咽癌患者临床分期的1种辅助性分子生物指标,具有较高应用价值。     

A high value of fibrinogen in immunoglobulin A nephropathy patients is associated with a worse renal tubular atrophy/interstitial fibrosis score

PurposeThe purpose of our study was to investigate the relationship between serum fibrinogen value and renal tubular atrophy/interstitial fibrosis in immunoglobulin A nephropathy patients with eGFR ≥90 ml/min/1.73 m².Patients and MethodsOf 359 patients diagnosed with immunoglobulin A nephropathy after renal biopsy were enrolled in this retrospective study. Demographic, histopathological features, and clinical data were collected. The relationships among these factors were analyzed by using Student''s t test, Mann‐Whitney U test, Kruskal‐Wallis test, Chi‐square test, or Fisher''s exact test, where appropriate. The logistic regression analysis was performed to examine the independent risk factors.ResultsOf 176 immunoglobulin A nephropathy patients with eGFR ≥90 ml/min/1.73 m² were included in this study, and patients were classified into low fibrinogen (fibrinogen <304.6 mg/dl) and high fibrinogen (fibrinogen ≥304.6 mg/dl) groups, respectively. High fibrinogen groups had advanced age, a higher classification of renal tubular atrophy/interstitial fibrosis, and higher levels of systolic pressure, D‐dimer, 24 h urine protein quantitation, nag enzyme. Multivariate logistic analysis showed that fibrinogen (OR = 1.018) was significantly associated with tubular atrophy/interstitial fibrosis.ConclusionAmong patients with immunoglobulin A nephropathy, the higher levels of fibrinogen and uric acid may mean a higher score of tubular atrophy/interstitial fibrosis, which suggests the renal biopsy should be performed for these patients as early as possible to defined pathological classification, even though there is no obvious abnormal change in the test of renal function.     

麻疹病人咽拭子标本的麻疹病毒分离结果

目的收集麻疹病人的咽拭子标本进行麻疹病毒分离,为我国麻疹病毒流行毒株基因型的鉴定提供更多的分离株。方法2005年5￣8月,选择南京市第二医院收治入院的疑似麻疹病人109例采集了咽拭子标本,接种EB病毒转化的狨猴淋巴母细胞(B95a细胞)。结果分离到麻疹病毒46株,分离阳性率为42.20%。结论此次南京第二医院与江苏省CDC合作分离到麻疹野病毒,标本量大,阳性率高,分析原因,与采集的时间、操作人员的技术及冷链储运和及时运输密切相关。     

腹腔镜手术治疗对良性卵巢肿瘤患者免疫功能的影响

目的研究良性卵巢肿瘤患者腹腔镜手术前后周围静脉血体液免疫、细胞免疫、急性期反应蛋白(CRP)及腹腔内细胞免疫功能的改变.方法术前抽取周围静脉自凝血2ml,应用全自动分析仪测定IgC,IIgA,IgM和CRP;抽取周围静脉防凝新鲜血2ml测定中性粒细胞吞噬功能.术后12h再次抽取周围静脉血测定上述指标.术中留取腹腔血性渗液测定中性粒细胞吞噬功能,并与术中测定的周围血相应值比较.结果周围血体波及细胞免疫功能术后12 h与术前相比明显降低(P＜0.05),CRP较术前明显升高(P＜0.05),腹腔内的中性粒细胞吞噬功能明显降低(P＜0.01).结论腹腔镜手术可降低良性卵巢肿瘤患者免疫功能.     

Increase of atypical lymphocytes expressing CD4+/CD45RO+ in an infectious mononucleosis-like syndrome associated with hepatitis A virus infection

Subpopulations of regular and atypical lymphocytes in the peripheral blood of a 24-year-old man with an infectious mononucleosis (IM)-like syndrome associated with hepatitis A virus (HAV) infection were analyzed. The ratio of CD4+ to CD8+ cells was in the normal range (1.19 and 1.23 in the regular and atypical lymphocytes, respectively), with no increase in CD8+ cells. The percentage of CD8+/CD11b- cells was not increased in the atypical lymphocytes. However, CD45RO+ was expressed on 86.3% of CD4+ atypical lymphocytes. The present data suggest that atypical lymphocytes expressing CD4+/CD45RO+ may play the role of helper T cells in the immune system in the development of IM-like syndrome associated with HAV infection.     

二维斑点追踪技术预测静脉注射免疫球蛋白抵抗急性期川崎病患者心肌损伤

目的 采用二维斑点追踪技术（2D STI）观察静脉注射免疫球蛋白（IVIG）抵抗急性期川崎病（KD）患者左心室心肌收缩功能损伤特点。方法 收集IVIG应答患者40例（IVIG应答组）,以诊断为急性期KD的住院患者中年龄、性别相匹配的IVIG抵抗患者40例为IVIG抵抗组,将后者进一步分为冠状动脉扩张（CAD）亚组和冠状动脉正常（NCAD）亚组,获取常规超声心动图参数、2D STI参数及实验室指标。比较IVIG抵抗组与IVIG应答组间常规超声心动图参数、2D STI参数和实验室指标,以及CAD亚组与NCAD亚组各参数间差异,并通过ROC曲线获取IVIG抵抗患者2D STI参数预测值。结果 与IVIG应答组相比,IVIG抵抗组CAD发生率、左心室质量及左心室质量指数均升高,收缩期左心室整体峰值纵向应变（GLS）及整体峰值环向应变（GCS）均减小,血清白蛋白、红细胞血沉速度、C反应蛋白及血小板均升高（P均<0.05）。以GLS绝对值16.8%为阈值,曲线下面积0.769（P=0.021）,预测IVIG抵抗的敏感度为79.27%,特异度为68.36%;以GCS绝对值15.9%为阈值,曲线下面积0.749（P=0.038）,预测IVIG抵抗的敏感度为71.43%,特异度为57.28%。结论 IVIG抵抗KD患者心肌损伤较IVIG应答KD患者更严重,可能是心肌炎性损伤而非冠状动脉损伤的结果。2D STI技术可预测急性期IVIG抵抗患者心肌损伤。     

埃博拉病毒病流行期西非归国发热患者留观期间的护理策略

目的：探讨埃博拉流行期间西非归国发热患者的护理策略及护理管理方法。方法采用前瞻性研究,用制定的应急预案对收治的西非归国发热患者进行干预,收集患者信息,给予发热患者心理疏导和人性化的护理,对干预措施和结果进行分析。结果2014年8月8日—10月20日,共收治36例发热留观病例,均排除埃博拉病毒感染,其中9例诊断为疟疾,均得到相应的治疗和护理,顺利解除留观。结论科学管理和健全有效的应急体制及较高传染病专业素质的护理队伍,对快速、有效应对突发传染病公共卫生事件具有重大意义。     

Paraneoplastic immunoglobulin A nephropathy in a patient with lung adenocarcinoma: A case report and literature review

Immunoglobulin A nephropathy (lgAN) is a common primary glomerulonephritis, but paraneoplastic IgAN has been rarely reported. This current case report describes a 49-year-old male patient that was referred with proteinuria, oedema and hypoproteinaemia after lung cancer surgery and before the first cycle of chemotherapy. Renal biopsy confirmed lgAN. The patient received four cycles of chemotherapy (first cycle: pemetrexed + nedaplatin; second to fourth cycle: pemetrexed + carboplatin). The symptoms of IgAN were gradually relieved with additional cycles of chemotherapy. At the latest follow-up on 10 February 2020, there was no evidence of lung cancer recurrence and all symptoms of lgAN had disappeared. lgAN combined with lung adenocarcinoma is quite rare, which suggests that IgAN might be a paraneoplastic manifestation of lung adenocarcinoma.     

The passive transfer of immunoglobulin G serum antibodies from patients with longstanding Complex Regional Pain Syndrome

Background: The aetiology of Complex Regional Pain Syndrome (CRPS) is unknown. Recent evidence suggests that there may be autoantibodies directed against peripheral nerves, but it is unclear whether such autoantibodies are merely biomarkers or whether they cause or contribute to the underlying pathology. The transfer of disease after injection of a patient's serum or IgG fraction into mice (‘passive transfer’) is the classic way to demonstrate a functional role of autoantibodies. Aims: Based on previous preliminary results, we wished to investigate whether the transfer of IgG antibodies affected mouse behaviour or produced signs of CRPS. Methods: We injected purified serum‐IgG from 12 patients and 12 controls into groups of 6–10 mice (～17 mg/mouse intraperitoneally) on 2 consecutive days and looked for any evidence for altered behaviour or signs of CRPS. The observer, blinded as to test or control group, measured behaviour in the open field, stimulus‐evoked pain and motor coordination, and inspected limbs for autonomic CRPS signs. Results: Stimulus‐evoked pain and autonomic signs were not detected, but CRPS‐IgG induced significant depression of rearing behaviour (17.9 rears/3 min (n =84) vs. 22.1 rears/3 min (n =83), p =0.0004), confirming previous observations in a single case study. Moreover, motor impairment, one of the four cardinal signs of CRPS, was evident in the three CRPS‐IgG injected groups tested with a sensitive rota‐rod protocol (p <0.0001 vs. control‐IgG injected groups). Conclusions: These results lend support to a pathophysiological role for IgG autoantibodies in CRPS.     

天津市某三甲医院维持性血液透析患者血源性病毒感染情况分析

【摘要】目的了解血液透析患者乙型肝炎病毒（hepatitisBvires,HBV）、丙型肝炎病毒（hepatitisCvirus,HCV）、人类免疫缺陷病毒humanimmunodeficiencyvirus,HIV）和梅毒螺旋体（treponemapal—lidum,TP）的感染情况。方法应用酶联免疫法检测449例维持性血液透析患者血清中HBV五项、抗-HCV、抗-HIV和TP抗体．应用PCR-荧光探针法检测HBsAg阳性的透析患者血清中HBV—DNA含量及抗-HCV阳性的透析患者血清中HCV—RNA含量,并进行统计学分析。结果449例透析患者HB．sAg、HBsAb、抗-HCV、TP抗体的阳性率分别为2．90％、20．71％、8．69％、1．78％,抗-HIV检测结果均为阴性。其中,HBsAg阳性患者中,HBV-DNA阳性率为46．15％,DNA拷贝数为1．1×104—3．7×10^7 IU／mL;抗-HCV阳性者中,HCV-RNA阳性率为58．97％,RNA拷贝数为8．1×10^3～1．5×10^7IU／mL。≥60岁和〈60岁两组患者HBsAg、抗-HCV阳性率比较,差异均无统计学意义（P均〉0．05）。结论血液透析患者HBV、HCV感染率相对国外较低,但感染现象在各年龄段普遍存在。TP感染情况与国内外报道相似,应加强管理防护。