14例儿童IgM肾病临床与病理探讨

目的：探讨儿童IgM肾病临床与病理之间的关系。方法：对首都儿科研究所附属儿童医院2004年10月～2009年3月经肾组织活检明确诊断为IgM肾病14例患儿的临床资料、肾组织病理、治疗方法和随访情况进行回顾性分析。结果：本资料50%IgM肾病临床表现为肾病综合征;肾脏病理显示以系膜增生病变为主,免疫荧光示8例单纯IgM沉积,5例IgM＋IgG沉积;结合临床和病理给予个体化治疗,有效率可达81.8%。结论：IgM肾病临床和病理存在着一定的关联性,临床表现为肾病综合征者病理损害较重。早期、规律、个体化治疗,近期疗效好。大量蛋白尿是预后不良的因素。     

两种ELISA试剂检测麻疹病毒IgM抗体实验室对比与评估

目的：对海泰两种麻疹病毒IgM抗体诊断ELISA试剂的实验室现场应用效果进行对比和评估。方法：同时采用该两种ELISA试剂和参比试剂对疑似麻疹患者的血清标本42份进行检测,并通过标本阳性检出率、敏感性、重复性、稳定性进行对比。结果：过夜法试剂在标本检出率、敏感性和稳定性都优于快速法试剂。结论：应制备外部对照质控血清,以便控制试剂和检测质量。疑似麻疹患者的血清标本OD值接近Cottoff值时,应采集第二份血清进行确诊。     

汉坦病毒N蛋白的重组表达及其用于IgM直接捕捉ELISA的建立和应用

目的克隆并表达汉坦病毒（HV）Z10株（HV—Z10）N蛋白（NP）编码基因，建立基于辣根过氧化酶（HRP）标记重组NP（rNP）的rNP—IgM直接捕捉ELISA，检测肾综合征出血热（HFRS）患者血清并评价其检测效果。方法PCR扩增HV—Z10株NP编码基因，基因工程方法构建NP编码基因原核表达系统pET28a—Z10N—E．coli BL21DE3。SDS-PAGE了解rNP表达情况，离子交换法和Ni—NTA亲和层析法提纯rNP。Western blot检测rNP的特异性免疫反应性。建立HRP标记rNP—IgM直接捕捉ELISA检测HFRS患者血清样品，并与常规HV—IgM间接捕捉ELISA进行比较。结果pET28a—Z10N—E．coli BL21DE3高效表达rNP。提纯rNPSDS-PAGE显示单一蛋白条带，HV-IgG能有效识别rNP并与之结合。94．73％（90／95）HFRS患者血清样品rNP—IgM直接捕捉ELISA检测结果阳性，HV—IgM间接捕捉ELISA阳性率为92．63％（88／95）。两种IgM捕捉ELISAs检测的HFRS患者血清样品A450值分布及对多份不同稀释度血清检测的A450，均值变化均相似。结论成功构建了HV—Z10株NP编码基因高效原核表达系统。所建立的rNP—IgM直接捕捉ELISA可作为HFRS简便、安全、敏感、特异的血清学诊断新方法。     

余姚市2000～2006年疑似麻疹病例血清学检测结果分析

目的分析余姚市2000～2006年麻疹患者血清抗体检测情况。方法采用酶联免疫吸附试验（ELISA）检测麻疹kM抗体。结果2000～2006年共采集疑似麻疹病例血清498例，实验室确诊病例211例，阳性率42．37％。冬春季阳性率高，麻疹IgM抗体阳性最小年龄为3个月12d，最大为42岁，主要集中在小于8月龄组。流动人口麻疹抗体阳性率高于常住人口。结论检测麻疹IgM抗体对病例的快速确诊、及时采取控制措施起到关键作用，建议重点对流动人口加强管理，提高麻疹疫苗的接种及时性和接种质量，加强麻疹的常规免疫、强化免疫，适时开展流动儿童的强化免疫。     

几种CMV相关物检测对诊断肾移植患者CMV感染的评价

目的 比较血中pp65抗原、DNA和IgM抗体检测对肾移植患者巨细胞病毒（CMV）活动性感染的诊断价值,为临床上对CMV感染的诊断和治疗提供参考.方法 收集83位肾移植患者的血标本（共302份）,分离血浆和多型核白细胞,血浆用于CMV-DNA（定性PCR）和IgM抗体（ELISA）检测,白细胞用于pp65抗原血症检测（荧光免疫法）.结果 CMV-DNA阳性率为36.1%,CMV IgM抗体阳性率20.2%,CMV pp65抗原阳性率为38.5%.pp65抗原阳性细胞数与病人的临床症状密切相关.结论 pp65抗原阳性细胞数能反应CMV的数量,可监测早期活动性CMV感染及疗效观察,检测方法特异,灵敏,操作简单,适合临床实验室应用.     

Plasma Antibodies to Cow's Milk Are Increased by Early Weaning and Consumption of Unmodified Milk, but Production of Plasma IgA and IgM Cow's Milk Antibodies Is Stimulated Even during Exclusive Breast-Feeding

ABSTRACT. We measured levels of cow's milk-specific (CM) antibodies of immunoglobulin classes G, A and M by enzyme-linked immunosorbent assay in plasma of 198 healthy infants; a variable number of samples taken at birth and at ages of 2, 4, 6, 9, 12 and 28 months were available (altogether 765 samples). The rise in the level of IgG CM antibodies was highest and most rapid in infants exposed to CM formula before the age of 1 month. The level fell by 9 months, but rose again by 12 months. This second rise was attributed to the introduction of dairy milk. Partially breast-fed and fully weaned infants had similar levels of IgG CM antibodies. The levels of IgG CM antibodies were unaffected by the infants' own atopy, their heredity for atopy, and the umbilical serum level of IgG CM antibodies. IgA and IgM CM antibodies were absent at birth. Their levels increased similarly in exclusively breast-fed infants and infants fed CM formula. We conclude that plasma IgG antibodies to cow's milk are increased by early weaning and by consumption of unmodified cow's milk. Production of plasma IgA and IgM antibodies to cow's milk is stimulated even during exclusive breast-feeding.     

Clinicl Significance of Mesangial IgM Deposits in Minimal Change Nephrotic Syndrome

The clinicopathologic features and the response to corticosteroid therapy were compared in 9 patients with minimal change nephrotic syndrome (MCNS) and diffuse mesangial IgM deposits (Group I) and in 32 of those without IgM deposits (Group II). However, serum IgM levels in Group I in both relapse and remission were significantly higher than those of Group II and controls (p<0.001). In Group I mesangial IgM deposits were diffuse in 9 (100%), mesangial C_1q was present in 4, IgA and fibrinogen were each observed in 1, respectively. Electron dense deposits in the mesangium were also present in 2 to 5 patients in Group I. No significant differences were found between the two groups in age of onset, sex ratio, laboratory data except for serum IgM level, duration before biopsy, follow-up periods, outcome, and response to steroid therapy. Our data suggest that a more severe degree of either impairment of mesangial clearance of IgM or overproduction of IgM may be involved in patients with MCNS and mesangial IgM deposits but that these patients could not be considered a distinct group of patients.     

惠州市麻疹患者血清流行病学调查

目的 了解惠州市麻疹病例血清流行病学特征，探讨麻疹发病原因。方法 对2003～2005年收集的390例麻疹疑似病例血清标本，采用酶联免疫吸附实验（ELISA）检测麻疹IgM抗体，麻疹IgM抗体阳性病例再用ELISA法检测麻疹IgG抗体。结果麻疹IgM抗体阳性率为76．6％，合格标本采集率34．1％。麻疹IgM抗体阳性病例麻疹IgG抗体阳性率64．9％；出疹与采血间隔天数长，IgG抗体阳性率和GMT高，≤1岁组病例IgG抗体阳性率和GMT水平最低。结论 麻疹发病主要原因是未接种麻疹疫苗（MY）和接种后原发性免疫失败，提高血清样本采集率和开展风疹血清学鉴别诊断是惠州市加强麻疹实验室监测亟待解决的问题。     

河北省麻疹实验室网络的建立和运转状况分析

目的评价河北省麻疹实验室网络(MLNW)在加速控制麻疹中的作用。方法对1999~2004年MLNW检测结果和数据进行分析。结果河北省1999~2004年麻疹监测系统共报告调查疑似麻疹5 474例,MLNW检测血清标本4 560份,实验室诊断率平均为83.30%,麻疹IgM抗体阳性率为49.06%,风疹IgM抗体阳性率为35.59%。2003、2004年MLNW接收标本后3d内及时检测率为73.60%(1 701/2 311)。2000~2004年发放考核标本763份,符合率为97.25%。2001~2004年复核检测标本730份,符合率为95.80%。2001~2004年省疾病预防控制中心(CDC)麻疹实验室接受中国CDC病毒病预防控制所国家麻疹实验室考核和标本复核检测,均为100分。河北省CDC共分离到3株麻疹病毒,均为H1基因型。结论MLNW的建立和正常运转,在麻疹监测中发挥了重要作用,疑似麻疹病例的实验室诊断率、3d内标本检测率、标本的检测符合率均维持在较高水平,现阶段河北省流行的麻疹野病毒为H1基因型。     

深圳地区献血人群弓形虫感染的血清学调查研究

目的了解深圳地区献血人群中弓形虫感染和分布情况。为医疗安全用血提供科学依据。方法采用酶联法(ELISA)检测标本血清中弓形虫的IgG、IgM，初筛检测阳性，复查仍为阳性，判断为阳性。结果对随机抽取的680例无偿献血者进行检测，检出IgG阳性为49例，IgG阳性率为7．21％；IgM阳性2例，IgM阳性率为0．29％。其中18～30岁、31．40岁、41．55岁IgG阳性率分剐为5．91％、7．04％和9．26％；在校大学生、外来打工人员、家庭妇女、公务员及企业职员阳性率分别为6．57％、6．98％、11．2％和6．12％；男性、女性IgG阳性率分别为7．6％、6．62％o结论献血者人群中弓形虫感染率随着年龄的增长有增高的趋势；家庭妇女组的阳性率高于其他3组人群；男女人群的阳性率差异无显著性。对于感染弓形虫的献血者存在潜在的输血传播该病的可能性应起重视。