多指标联合检测在肝硬化合并感染诊断中的价值

目的 分析降钙素原(PCT)、白介素6(IL-6)、C反应蛋白(CRP)、中性粒细胞CD64、白细胞总数(WBC)、中性粒细胞百分比(NEU%)等多种指标诊断肝硬化患者早期感染的临床价值。方法 将肝硬化住院患者按照细菌培养结果和临床症状分为感染组和非感染组,血清PCT、IL-6采用化学发光分析仪进行检测,血清CRP采用生化分析仪进行检测,中性粒细胞CD64采用流式细胞分析仪进行检测,WBC和NEU%采用全血细胞分析仪进行检测。数据采用Logistic回归和ROC曲线进行分析。 结果 感染组各个指标均显著高于非感染组(P<0.01); Logistic回归分析结果表明PCT、IL-6和CD64具有早期预测肝硬化合并感染的能力,其OR值分别为7.199(95%CI,2.180-23.771),1.010(95%CI,1.002-1.017)和2.312(95%CI,1.485-3.600)。然而CRP、WBC和NEU%则不具有早期预测价值;ROC曲线分析结果显示,PCT、IL-6和CD64的曲线下面积AUC分别为0.791(95%CI,0.727-0.856),0.762(95%CI,0.693-0.832)和0.884(95%CI,0.835-0.933);三者联合检测的ROC曲线下面积AUC为0.932(95%CI,0.897-0.967),诊断准确率为86.9%。 结论 PCT、IL-6和CD64可以作为早期诊断肝硬化合并感染的指标,三者联合检测能够提高临床诊断效率。     

IgE Reactivity of the Dog Lipocalin Allergen Can f 4 and the Development of a Sandwich ELISA for Its Quantification

Purpose

Divergent results on the IgE reactivity of dog-allergic subjects to Can f 4 have been reported. The aim of this study was to evaluate the significance of Can f 4 in dog allergy and to develop an immunochemical method for measuring Can f 4 content in environmental samples.

Methods

We purified the natural dog allergen Can f 4 from a dog dander extract by monoclonal antibody-based affinity chromatography and generated its variant in a recombinant form. Sixty-three dog-allergic patients and 12 nonallergic control subjects were recruited in the study. The IgE-binding capacity of natural Can f 4 and its recombinant variant was assessed by ELISA, immunoblotting, and skin prick tests (SPT).

Results

Eighty-one percent of the dog-allergic patients showed a positive result to the immunoaffinity-purified natural Can f 4 in IgE ELISA, but only 46% in IgE immunoblotting. Respective results with the recombinant Can f 4 variant were 54% and 49%. SPT results reflected those obtained in ELISA and immunoblotting. The overall IgE reactivity of the immunoaffinity-purified natural Can f 4 was found to depend strongly on the integrity of the allergen''s conformation. A sandwich ELISA based on monoclonal antibodies was found to be functional for measuring Can f 4 in environmental samples.

Conclusions

Can f 4 is a major allergen of dog together with Can f 1 and Can f 5. In combination with other dog allergens, it improves the reliability of allergy tests in dog allergy.     

牙周致病菌免疫逃逸机制的研究进展

牙周致病菌可引起牙周组织慢性炎症,由其引发的宿主过度的免疫炎症反应会进一步加重牙周组织的损伤。本文就龈沟的天然免疫防御机制,微生物对龈沟防御机制的敏感性,中性粒细胞和牙龈上皮细胞对牙周致病菌的免疫反应进行系统阐述,旨在表明真正的牙周致病菌因不能很好地激发或者抑制宿主的免疫反应,从而逃避宿主的免疫防御,导致牙周炎的发生,为牙周病的治疗和早期预防提供参考依据。     

Neutrophil–lymphocyte ratio: a novel predictor for short‐term prognosis in acute‐on‐chronic hepatitis B liver failure

Acute‐on‐chronic hepatitis B liver failure (ACHBLF) has a poor prognosis in patients with hepatitis B virus infection. The role of the neutrophil–lymphocyte ratio (NLR), which reflects the inflammatory status of the patient before treatment, has never been studied in this setting. To investigate the predictive value of NLR in patients with ACHBLF, a retrospective cohort with 216 patients and a prospective validation cohort with 73 patients were recruited. Multivariate analyses showed that total bilirubin (TBIL), NLR, age and model for end‐stage liver disease (MELD) score had prognostic significance for survival. Both NLR (0.781) and MELD score (0.744) had higher ROC curves, which differed significantly from those for age (0.615) and TBIL (0.691), but not from each other (P = 0.94). NLR ≤2.36 predicted lower mortality (with 91.6% sensitivity and 86.0% negative predictive value), and NLR >6.12 was a warning sign for higher mortality risk (with 90.1% specificity and 80.3% positive predictive value). These results demonstrated that pretreatment NLR was associated with the prognosis of patients with ACHBLF, and elevated NLR predicted poor outcome within 8 weeks. We suggest that NLR cut‐offs of ≤2.36 and >6.12 are powerful markers for predicting mortality in ACHBLF.     

Evolving concepts of pathogenesis of heparin‐induced thrombocytopenia: Diagnostic and therapeutic implications

Heparin‐induced thrombocytopenia (HIT) is an immune reaction to heparin. It often causes severe thrombosis which may lead to limb gangrene and thrombosis‐associated death. The concept of its pathogenesis has been evolving during the past five decades. Initially, HIT was thought to be caused by disseminated intravascular coagulation. Later it became clear that HIT was mediated by an immune mechanism whereby an IgG antibody induced platelet aggregation, release of procoagulant materials and consequently thrombus formation. The antigen comprises Platelet Factor 4 (PF4) and heparin which have a tendency to form ultralarge complexes. The HIT immune response has atypical features. IgG antibody appears early without IgM precedence and lasts transiently. One explanation is that there is prior priming by bacterial infection. Another unique characteristic is that it is processed as if it is a particulate antigen involving complement activation and B cells. Antigen‐presenting cells/monocytes are also involved but the role of T cells is controversial. Recent advances have provided new insights into the underlying mechanisms of HIT‐related thrombosis. Previously, platelets were believed to play a central role; their activation and consequently the induction of blood coagulation was the basis of the hypercoagulability in HIT. More recently, several studies have provided clear evidence that neutrophil and NETosis, monocytes and endothelial cells contribute significantly to the thrombosis in HIT. These new insights may result in development of better diagnostic laboratory assays and more effective treatments for HIT.