Serum thyroglobulin and its autoantibody following subtotal thyroid resection of Graves'' disease

Thyroid surgery leads to marked changes of the levels of serum thyroglobulin and its autoantibodies in the subsequent 3 postoperative weeks. Furthermore in Graves' disease progression of exophthalmos has sometimes been seen following thyroidectomy. Nineteen medically pretreated patients with Graves' disease and no signs of exophthalmos were studied systematically up to 6 months postoperatively. Nine patients had thyroglobulin antibodies. Mean values rose to 3.5 times pretreatment values within 2 months (P less than 0.001) followed by a gradual fall below pretreatment level after 6 months. None of the antibody negative patients reverted to positive or vice versa. Serum thyroglobulin (n = 10) was elevated preoperatively (mean 309 micrograms/l, SD 251), their values being normalized within 1-2 months (mean 19.4 micrograms/l, SD 7.3). The preoperative serum thyroglobulin correlated to the weight of the removed thyroid tissue (r = 0.87, P less than 0.01). Three patients showed elevated thyroid stimulating hormone after 1 month. Of these, two developed myxoedema, the third remained euthyroid with persistently elevated serum thyroglobulin. None showed recurrence or developed exophthalmos within the period of observation. In spite of rising levels of thyroglobulin antibodies in all patients with antibodies none developed exophthalmos and only one patient with thyroglobulin antibodies had clinical myxoedema.     

Comparison of IgG subclasses and complement binding activity of autoantibodies from patients with bullous pemphigoid and pemphigus

Bullous pemphigoid and pemphigus are autoimmune disorders of skin of unknown etiology and are characterized by the presence of immunoreactants in the skin and circulating autoantibodies to skin components. The distribution of IgG subclass antibodies to intercellular substance (ICS) of pemphigus and basement membrane zone substance (BMZ) of bullous pemphigoid was analyzed by using monoclonal antibodies to human IgG subclasses. IgG4 type anti-BMZ antibody was found in the majority of patients with bullous pemphigoid (88% in skin and 96% in serum). One third to one half of bullous pemphigoid patients had IgG1 and IgG2 anti-BMZ antibodies. The majority of bullous pemphigoid skin (92%) had complement in skin, however only one third of their sera had complement binding activity in vitro. IgG1 anti-ICS antibody was the predominant one in patients with pemphigus (86% in skin and 80% in circulation). IgG4 anti-ICS antibody was seen in two thirds of specimens from pemphigus patients. IgG3 subclass antibody was more frequently seen in pemphigus than in bullous pemphigoid patients. Two-thirds of pemphigus sera were capable of activating complement in vitro. The complement binding activity was directly associated with IgG1 and/or IgG3 subclass antibodies. The possible mechanisms for the restricted IgG4 subclass antibodies in bullous pemphigoid and pemphigus are discussed.     

Total IgG method insensitivity to the presence of IgG4 immunoglobulins

Objective

IgG4 related disease (IgG4RD) is detected in part by measurement of serum IgG4 levels in patients suspected to have the condition. The immunonephelometric methods that are used to measure serum IgG4 are susceptible to hook effect errors. The quality control parameter IgGRDiff = 100 ∗ [Sum (IgG1, IgG2, IgG3, IgG4) − Total IgG] / Average [Sum (IgG1, IgG2, IgG3, IgG4), Total IgG] is theoretically of use in detecting large IgG4 hook effect. We evaluated the IgGRDiff parameter in this context.

Design and methods

Retrospective review of the IgGRDiff parameter in a cohort of patient samples. All samples were tested with the Siemens BNII analyzer utilizing Siemens (total IgG) and Binding Site (IgG subclass) reagents. The 95th percentile for the absolute value of IgGRDiff was determined and compared to the IgGRDiff values for the samples with known hook effect error. IgGRDiff was regressed against IgG4Rsum [IgG4Rsum = 100 ∗ IgG4 / (IgG1 + IgG2 + IgG3 + IgG4)].

Results and discussion

The 95th percentile of the absolute value of the IgGRDiff parameter was 22.8% in our study sample set (n = 163). The absolute value of the IgGRDiff was < 22% in 4/6 cases indicating low sensitivity of IgGRDiff in identifying IgG4 hook effect errors. IgG4Rsum was directly correlated with IgGRDiff (IgGRDiff = 1.21 ∗ IgG4Rsum − 7.9, R² = 0.62) indicating that the total IgG measurement has little or no reactivity with IgG4 immunoglobulins.

Conclusions

The Siemens’ Total IgG method is insensitive to IgG4 and should not be used as a quality control parameter to detect IgG4 hook effect.     

Graves'' immunoglobulins and cytokines stimulate the expression of intercellular adhesion molecule-1 (ICAM-1) in cultured Graves'' orbital fibroblasts

Intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function-asociated antigen-1 (LFA-1) are cell surface adhesion receptors that bind to one another and promote a variety of effector/target cell interactions in tissues affected by inflammatory or immune processes. Local infiltration of the thyroid gland and the retro-ocular space by mononuclear cells is a hallmark of Graves' disease and Graves' ophthalmopathy (GO). Thus, we studied the role of these adhesion receptors in the interaction of inflammatory cells with retro-ocular fibroblasts (OF) derived from patients undergoing transantral decompression for severe GO, and from normal individuals. Confluent OF-monolayers were incubated with various cytokines or protein-A affinity-purified IgGs prepared from sera of patients with severe GO, Hashimoto's thyroiditis (HT), rheumatoid arthritis (RA) and normal individuals. As determined by immunocytochemistry and immunoprecipitation using a monoclonal anti-ICAM-1 antibody, interleukin-1-alpha (IL-1a), tumour necrosis factor-alpha (TNFa) and interferon-gamma (IFNg) strongly enhanced surface expression of ICAM-1 in both GO- and normal OF. By contrast, Graves' IgGs stimulated ICAM-1 expression only in GO-, but not in normal OF. No effect was observed in either cell type with interleukin-2, transforming growth factor-beta, or IgGs from patients with HT, RA and normal individuals. Using phorbol ester-activated, 51Cr-labelled peripheral blood mononuclear cells (PBMCs) in a cell adhesion assay, we demonstrated potent adhesive activity of ICAM-1 in GO-OF pretreated with IL-1a, TNFa, IFNg or Graves' IgGs, while all other compounds did not affect PBMC adhesion to GO-OF.(ABSTRACT TRUNCATED AT 250 WORDS)     

自身免疫性疾病和慢性肝病IgG4增高者血清IgG4／IgG分析

目的：探讨自身免疫性疾病和慢性肝病IgG4增高者血清中IgG4／IgG二组差异,并与健康人群进行比较。方法收集上海市仁济医院南院门诊和住院的自身免疫性疾病患者血清25例,慢性肝病患者伴IgG4增高者血清49例,以健康体检者血清30例作为对照组。利用免疫散射比浊法分别检测上述三组患者血清IgG4和IgG水平,计算IgG4与IgG比值,并分析三组之间血清IgG4水平和IgG4／IgG值的差异。结果与对照组相比,自身免疫性疾病组和慢性肝病伴IgG4增高组IgG4水平均显著升高,IgG4／IgG值均显著升高（P＜0．05）。与慢性肝病伴IgG4增高组相比,自身免疫性疾病组IgG4水平和IgG4／IgG值均显著升高（P＜0．05）。结论本文结果显示自身免疫性疾病患者和慢性肝病伴IgG4增高患者IgG4与IgG水平并非成一定比例增高,IgG4具有含量和比例增高现象,说明IgG4单项检测和IgG4／IgG检测对鉴别自身免疫性疾病和慢性肝病具一定临床价值。     

老年性痴呆患者鞘内IgG合成率测定及意义

目的探讨老年性痴呆（ＡＤ）患者鞘内ＩｇＧ合成率与临床的关系。方法采用火箭电泳法（ＲＩＥ）检测ＡＤ患者和正常对照老年人 ６３例配对脑脊液和血清中 ＩｇＧ、白蛋白水平。并计算出每 ２４ ｈ鞘内 ＩｇＧ合成率。结果血清、脑脊液中白蛋白水平和 ＩｇＧ水平在三组间存在较大的重叠,无显著性差异;老年人 ２４ ｈ ＩｇＧ鞘内合成率增高较多,而且以多梗死性痴呆组升高最为显著。结论脑梗死时中枢神经系统存在异常免疫应答,但与 ＡＤ组相比无显著性差异。脑脊液 ２４ ｈ ＩｇＧ鞘内合成率增高可能反映老年人血脑通透性存在损伤,但难以确定与痴呆的关系。     

IgG4相关性疾病的临床病例评析

目的提高对IgG4相关性疾病颅内病变的认识。 方法描述1例IgG4相关性疾病（IgG4-RD）颅内病变患者的诊治过程,总结其临床、影像学、病理特点,诊断和鉴别诊断,治疗和预后。 结果22岁女性,头痛、左眼视力下降10个月。6个月前左眼失明,眼球固定,左眼球后占位,病理示大量淋巴浆细胞浸润,IgG4＋浆细胞>50/高倍视野,IgG4（＋）/IgG比值>10%,予足量激素及小剂量免疫抑制剂治疗病情维持原状。2个月前停药。半月前突发右眼视力下降伴头痛加重,5天前右眼失明伴烦渴多尿,高钠血症。头颅MRI提示右侧视神经、鼻窦、鞍区、左侧颞叶及邻近脑膜异常信号。脑脊液压力、细胞学、生化均正常。予大剂量激素冲击治疗,序贯减量,联合环磷酰胺冲击治疗,患者右眼视力逐步恢复至0.3,头痛完全缓解,尿量改善,血钠正常。40余天后复查头颅MRI本次新发病灶明显好转。 结论IgG4-RD颅内病变可同时累及多个部位,但不伴颅外表现,可出现病情快速进展,及时治疗可避免不可逆损害。     

Performance evaluation of serum IgG subclass quantification using a SPAPLUS turbidimetric analyzer and comparison with the BNII nephelometer

Abstract

IgG consists of four subclasses: IgG1, IgG2, IgG3, and IgG4. Changes in the serum concentration of each subclass reflect different clinical situations, and quantification of each subclass is important to assess patients’ clinical states. Herein, we evaluated the analytical performance of the SPAPLUS turbidimetric analyzer (The Binding Site, Birmingham, UK) for IgG subclass. Precision, linearity, comparison with the BNII system (Siemens Healthineers, Erlangen, Germany), and reference interval were assessed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The repeatability and within-laboratory precision were within 5% for all IgG subclasses. The coefficient of determination (R²) was higher than 0.99 for the analytical measurement range in all IgG subclasses. Comparison between SPAPLUS and BNII revealed significant differences in IgG1, IgG3, and IgG4 (p?相似文献   

LDL and HDL subclass distribution in patients with end-stage renal diseases

OBJECTIVES: To examine the alterations in LDL and HDL subclass distribution in ESRD patients compared with a control group and to investigate the relationship of LDL particle size to the other plasma lipoproteins levels. DESIGN AND METHODS: Plasma lipids, LDL and HDL subclasses were determined in 63 hemodialysis patients (HD), 42 predialysis patients and 345 control subjects. Lipoprotein subclasses were separated by polyacrylamide 3 to 31% gradient gel electrophoresis. RESULTS: In predialysis group, 88% subjects had small LDL particles compared with 58.5% of hemodialysis patients and 16.5% of control subjects. Mean LDL size particle diameter was significantly smaller in HD and predialysis patients in comparison with controls (p < 0,0005, p < 0,0001; respectively). Significant inverse correlation between LDL particle size and triglyceride level was observed for both patient groups. Decreased levels of the largest HDL2b subclass was found in both predialysis (16.5%) and in HD patients (30%) as compared with controls (50%), and increased levels of the small HDL3a subclass was found only in predialysis group (21%) in comparison with controls (4.5%). CONCLUSIONS: Alterations in LDL and HDL subclass distribution toward smaller particles is the main lipid abnormality associated with atherogensis found in ESRD. ESRD is associated with reduced levels of HDL2b subclass and increased levels of HDL3c subclass, which occurs in coronary artery disease (CAD) as well.     

IgG4相关性疾病的发病机制及进展

IgG4相关性疾病是一种多器官、多系统受累的新被认识的疾病,其主要特征为:血清IgG4水平升高和病变组织IgG4⁺浆细胞浸润。IgG4相关性疾病临床表现复杂多样,可涉及多个学科,临床易漏诊和误诊。本篇综述将从基因遗传、感染和分子模拟、免疫学角度等多方面阐述IgG4相关性疾病的发病机制,以加深临床医师对该病的了解。     

Graves甲亢131I治疗中动态监测血清TPOAb的临床价值

目的探讨Graves甲状腺功能亢进症（简称甲亢）^131I治疗前后动态监测抗甲状腺过氧化物酶抗体（TPOAb）水平变化及其对治疗效果及预后的评判价值。方法112例Graves甲亢患者和50例健康对照者分别于^131I治疗前及治疗后3、6、12和24个月采用化学发光法（CLIA）测定其血清TPOAb水平。数据用x^-&#177;s表示，组间差异用方差分析与t检验。结果112例Graves甲亢患者在^131I治疗前血清TPOAb水平[（81．95&#177;47．64）IU／mL]高于健康对照组（P〈0．01）。在^131I治疗后3个月血清TPOAb水平[（108．94&#177;70．15）IU／mL]明显高于治疗前（P〈0．01），治疗后6个月患者血清TPOAb水平[（42．78&#177;28．68）IU/mL]开始降低，但与对照组比较差异仍有统计学意义（P〈0．01），在^131I治疗12个月后血清TPOAB水平[（19．56&#177;10．39）IU／mL]明显降低（P〈0．01），到24个月患者血清TPOAb水平[（7．89&#177;4．01）IU／mL]与对照组比较差异无统计学意义（P〉0．05）。结论在^131I治疗前检测血清TPOAb水平可作为^131I用量的辅助指标；在^131I治疗后检测Graves甲亢患者的TPOAb水平有助于随访监测及疗效评价，还可了解治疗后的免疫反应状态。     

IgG4相关性疾病的临床诊断学特征

目的探讨IgG4相关性疾病(IgG4-RD)的临床诊断学特征。 方法回顾性分析2015年1月至2018年6月泰安市中心医院经病理科确诊的3例IgG4-RD患者的临床资料,观察IgG4-RD的病理形态学特点及免疫表型。 结果患者中男性2例,女性1例,年龄76～80岁;3例患者均血清IgG4升高;CT检查可见相应部位或器官弥漫性或局限性肿大;病灶标本光镜下均可见弥漫或片状淋巴细胞及IgG4^＋浆细胞浸润;浸润细胞周围有特征性的纤维化,典型呈"螺旋环"状,伴有腮腺、肾小管等的萎缩。 结论IgG4-RD是一种少见的慢性自身免疫性疾病,以高血清IgG4水平及组织中大量IgG4^＋的浆细胞浸润、伴有显著纤维化为特征;临床、影像学及组织学表现均易与肿瘤等疾病相混淆,掌握其临床特征并结合免疫组化方能正确诊断。     

Immunoglobulins and IgG subclasses in children following severe head injury

Objective To study immunoglobulin production after severe blunt head trauma in children.Design Serum for IgG, IgM, IgA, IgE, and IgG subclasses were drawn from 10 children admitted with severe head injury (ISS 31.2, GCS 5.4) on day 1, 7, 14 and 21 after injury.Results 5 of the 10 patients developed infection between 7 and 14 days and 2 died of complications of pneumonia. On day 1, IgM levels averaged 95.6% of the mean of the age-specific normal controls. By day 7, IgM levels averaged 383% (p<0.01). While all patients were within the age-specific normal range (± 2 SD) on day 1, 7 of 10 patients were above the normal range by day 7. There was no difference in IgM levels between infected and non-infected patients. Five patients were below the age-specific normal range for IgG on day 1, with 3 still low on day 7. By day 21, IgG levels averaged 141% of the mean of the age-specific normal controls. IgG subclasses followed a pattern similar to total IgG levels. Marked increases in IgE were seen in 3 patients.Conclusions IgM levels increased dramatically in all patients within seven days of the injury. While 50% of these children had a deficit of IgG in the first week, total IgG and IgA levels increased after injury, but not as rapidly as IgM levels. Unlike pediatric burn patients, there is no persistent hypogammaglobulinemia following severe blunt trauma in children.Supported by a grant from Sandoz Pharmaceuticals, East Hanover, New Jersey, USA     

甲状腺超声显像在突眼性甲状腺肿复发预测中的价值

本文对137例突眼性甲状腺肿（Graves病，GD）患者进行了甲状腺超声检查旨在探讨其在GD复发预测中的价值。137例分为初发组（n=56），治疗组（n=20），复发组n=46），缓解组（n=15），设对照阻（n=19）。结果显示：复发组中甲状腺回声异常显著高于其它各组（p＜0.001），甲状腺回声异常诊断GD停药后GD复发的敏感性为0．87，特异性为0．93。甲状腺回声可以作为预测GD复发的一较可靠指标。     

甲亢患者手术前后TSH受容体抗体的变化及临床意义

目的探讨作为甲状腺机能亢进症（甲亢）主要发病因子的ＴＳＨ受容体抗体（ＴＲＡｂ）在甲状腺切除手术前、后的变化及其临床意义。方法对９１例甲亢患者进行ＴＲＡｂ追踪测定，并根据术前ＴＲＡｂ值将其分为正常组，弱阳性组，中度阳性组和强阳性组，分别讨论其变化特点。结果术前ＴＲＡｂ阳性例术后１２～１８月间大部分转为正常或呈明显下降趋势；而甲状腺机能则全部转为正常或潜在性低下及低下状态。阳性组ＴＲＡｂ术后恢复正常的例数所占比率分别为２５／２７、１０／１７和２／８。结论外科手术治疗甲亢可以使ＴＲＡｂ转为阴性，因此，不但在临床上而且针对病因治疗也都有效，但目前尚无法治愈所有甲亢患者。     

IgG4相关性肺疾病19例临床分析

目的 通过分析19例IgG4相关性肺疾病(IgG4-RLD)的临床特点,为临床医生对该病的早期诊治提供参考.方法 纳入2014年4月至2019年12月首次于四川大学华西医院就诊的19例IgG4-RLD患者作为研究对象,收集并分析其基本临床特征、实验室检查、影像学检查、组织病理学检查、治疗与随访结果等资料.结果 19例患...     

IgG4相关性疾病的诊疗进展

IgG4 相关性疾病是一种与IgG4 淋巴细胞密切相关的慢性、系统性疾病,该类疾病以血清IgG4 水平升高以及IgG4 阳性细胞浸润多种器官和组织为特征,病理学改变呈现为席纹状纤维化,累及的器官或组织由于慢性炎症及纤维化进程可导致弥漫性肿大,常见受累器官包括泪腺、胰腺和腹膜后间隙等。该类疾病对皮质激素治疗反应良好。文中我们回顾了IgG4 相关性疾病前阶段的诊断标准,并补充不常见受累器官的国际诊断标准,更新各个诊断标准的国际共识,认为免疫抑制剂、生物制剂将成为治疗的新进展。     

甲状腺自身抗体在自身免疫性甲状腺疾病诊断中的应用价值

目的 探究甲状腺自身抗体在自身免疫性甲状腺疾病(AITD)诊断中的应用价值.方法 选择2019年5月至2020年5月我院收治的80例AITD患者作为AITD组,其中34例为桥本甲状腺炎(HT),46例为毒性弥漫性甲状腺肿(Graves病);另选取同期我院50例健康体检者作为对照组.比较各组的促甲状腺激素受体抗体(TRA...