2型糖尿病肾病糖化血红蛋白等代谢指标的相关性分析

目的 探讨2型糖尿病肾病糖化血红蛋白(HbA1C)、血脂、收缩压(SBP)之间的相关性,以指导临床医生及早防治.方法 128例2型糖尿病患者按照尿白蛋白排泄率(UAER)分为糖尿病肾病组和非糖尿病肾病组,测定并对比分析两组患者的空腹血糖(FBG)、餐后2小时血糖(2hPG)、HbA1C总胆固醇(TC)、HbA1C甘油三酯(TG)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、SBP.结果 糖尿病肾病组FBG、LDL-C、TG、TC、SBP均高于非糖尿病肾病组(P＜0.01).结论 早期控制血糖、血脂、血压,缩短病程,是防止糖尿病肾病发生发展的关键.     

扁桃体切除对IgA肾病患者肾生存影响的Meta分析

目的 用Meta分析方法评估扁桃体切除对IgA肾病患者肾生存的影响.方法 查询筛选合格病例对照研究文献6篇,Meta分析采用Review Manager 4.2统计软件,对文献结果进行定量综合分析.结果 (1)同质性检验异质性检验x2=21.99,P＜o.05,表明6项扁桃体切除对IgA肾病患者肾生存影响的对照研究具有同质性,可以合并结果;(2)合并效应量的检验Z=3.29,P＜0.05,合并效应量OR采用固定效应模型,OR合并值为0.46(95%CI 0.29-0.73),菱形完全在垂直线的左侧.结论 IgA肾病患者行扁桃体切除可改善其肾生存情况,但需要考虑其禁忌症和适应症,在发病早期切除扁桃体.     

Current status of a mucosal vaccine against dental caries

The evidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease. Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses. Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine. Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life. Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci. The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization.     

IgA1 is the major IgA subclass in cutaneous blood vessels in Henoch-Schönlein purpura

Henoch–Schönlein purpura (HSP) is characterized by palpable purpura predominantly involving the lower extremities. On direct immunofluorescence IgA can be seen deposited in the blood vessel walls of the superficial dermis. The subclass distribution of antibodies to this IgA was studied in the biopsies of 28 patients with HSP by direct immunofluorescence using anti-IgA1 and anti-IgA2 specific monoclonal antibodies. All 28 patients’ biopsies demonstrated deposition of IgA1 while only one patient had IgA2 deposition. Positive and negative controls stained appropriately. This demonstrates that IgA1 is the dominant IgA subclass found in the skin in Henoch–Schönlein purpura.     

Metastatic cutaneous plasmacytoma: a case report associated with IgA lambda multiple myeloma and a review of the literature of metastatic cutaneous plasmacytomas associated with multiple myeloma and primary cutaneous plasmacytomas.

We present the case of a 67-year-old Japanese woman with immunoglobulin A lambda (IgA lambda) multiple myeloma (MM). She had firm nodular cutaneous lesions on the trunk and scalp without adjacent bone involvement. The patient was diagnosed as having IgA lambda MM of stage IIIA with 52% plasmacytosis in the bone marrow six months before the appearance of the cutaneous lesions. The abnormal plasma cells showed moderate to marked dysplasia in both the bone marrow and skin lesions. The abnormal plasma cells in the bone marrow exhibited abnormal karyotypes: 41, XX, der (1) t (1p; 1q), -4, -10, -14, -16, -17, 17p+, that differed from the "unfavorable" karyotype reported previously. We reviewed the cases of metastatic cutaneous plasmacytoma in MM and cases of primary cutaneous plasmacytoma that have been reported in English or Japanese and identified the Ig class. Among the 83 cases of metastatic cutaneous plasmacytomas in MM, IgG, IgA, IgD, and Bence-Jones protein were found in 52%, 23%, 16%, and 6%, respectively. A disproportionately high frequency of IgD lambda MM was found to have spread to the skin, compared with the frequency of IgD MM itself, which was present in only around 2% of the MM cases. Among the 18 primary cutaneous plasmacytomas, IgG, IgA, and Bence-Jones protein were found in 56%, 11%, and 17%, respectively, but no IgD was found.     

Glomerular, tubular and interstitial nephritis associated with non-steroidal antiinflammatory drugs. Evidence of a common mechanism

AIMS: To study the mechanisms behind NSAID-associated nephropathy. METHODS: Analysis of published case reports satisfying strict criteria for NSAID nephropathy. RESULTS: Ninety-seven cases with acute nephritis (AN; 19 patients), minimal change nephropathy (MC; 38 patients), membranous glomerulonephritis (MGN; 19 patients), focal sclerosis (FS; 13 patients) and other glomerulonephritis subgroups (8 patients) were identified. Hypersensitivity reactions were seen in all groups, most often in AN. Proteinuria was more severe in MC and FS than in MGN and unrelated to amount of glomerular deposits. The mean NSAID treatment time was 1.7 months in AN, 8.2 months in MC and 39 months in MGN and associated with amount of glomerular deposits, fusion of podocytes and proteinuria, and inversely associated with hypersensitivity, interstitial damage and renal failure. Rheumatic diseases were common in MGN. At follow-up 68 of 72 patients who had discontinued NSAID treatment had improved, 57 with normal renal function. CONCLUSIONS: NSAID nephropathy may be caused by hypersensitivity. The reaction is milder than in drug-induced acute tubulointerstitial nephritis, probably because the offending drug inhibits the inflammatory reaction it has started itself. Heavy proteinuria is probably due to lymphokines produced as a result of the immunological response. If the allergic reaction is strong, AN is produced rapidly with severe renal failure but little proteinuria; if it is less violent, immunocompetent cells may develop to produce lymphokines and proteinuria. Immune complexes may be formed eventually, secondary to the increased glomerular permeability, more easily in patients with a hyperactive immune system and with little consequence for renal function.     

SERUM IMMUNOGLOBULIN LEVELS IN THE COURSE OF ANAPHYLACTOID PURPURA IN CHILDREN

Abstract. Serum levels of immunoglobulins (IgG, IgA, IgM, IgD and IgE) were determined at frequent intervals in the course of anaphylactoid purpura (AP) in children. AP was cured without complications in 16 out of 26 cases, recurring in 7 cases. Melena was manifested in 9 cases and nephropathy in 5. The levels of IgA and IgM were elevated in AP, but serum IgG, IgD and IgE showed no significant changes. The serum level of IgM was significantly (p<0.0125) higher in patients with AP nephropathy than in those with recent AP. The elevated serum IgA and IgM levels are possibly related to the pathogenesis of AP and/or its renal involvement.     

Combined IgA and alpha-1-antitrypsin deficiency in a boy with severe respiratory tract infections and asthma

A five-year-old boy is described, who at 3 months of age presented with severe respiratory tract infections and later om developed signs of bronchial asthma and radiologic evidence of chronic emphysema and bronchiectasis. IgA was absent in his serum and saliva, and low serum alpha-l-antitrypsin levels with the phenotype PiMZ were found in the patient. Such dual deficiencies appear to be unusual. However, the association of IgA and alpha-l-antitrypsin deficiency should be considered in the evaluation of children with severe respiratory tract infections.     

THE MUCOSAL IMMUNE RESPONSE IN THE NEONATE

Hanson LÅ, Brinton C, Carlsson B, Dahlgren U, Mellander L, Sutton A and Söderström T. (Departments of Clinical Immunology and Paediatrics, University of Göteborg, Sweden, Bureau of Biologies, FDA, Bethesda, and Department of Life Sciences, University of Pittsburg, USA). The mucosal immune response in the neonate. Acta Paediatr Scand, Suppl. 296:53, 1982. — Human infants are relatively deficient in the IgA system defending mucosal membranes, but are provided via the maternal milk with considerable amounts of SIgA directed against microbes and food antigens to which both mother and infant are exposed. It is possible that serum antibodies may support the mucosal defense as do the lactoferrin, lysozyme and other defense factors present in the milk.     

白色念珠菌粘附肠上皮细胞及IgA对其作用的体外观察

目的:观察特异IgA抑制白色念珠菌(白念菌)粘附的作用.方法:首先建立肠上皮细胞IEC-6在玻片表面生长模型;将特异IgA阳性肠粘液、阴性肠粘液以及抗IgA血清中和后的肠粘液分别作用白念菌,收集菌并与上述细胞共同孵育.计数粘附数,并换算出抑制率.结果:含有特异抗白念菌IgA的肠粘液抑制白念菌优于其它肠粘液.结论:特异IgA在肠粘液中起重要的抗粘附作用.