应用DIFA等三项试验联合筛选孕妇弓形虫感染的研究

用DIFA初筛检测197例武汉地区非选择性孕妇，其弓形虫抗体阳性率为8．12％（16／197）；阳性者用IFT—IgG复查，阳性符合率为93．75％，即阳性率为7.61％（15／197），15例阳性者的滴度分别为1：164例，1:649例，≥1：10242例；DIFA阳性者还用Toxo－IgG／IgA／IgM－ISAGA检测，有2例IgA和IgM均为阳性。其中1例IgA1：64（＋）、IgM1：16384（＋）为急性弓形虫感染件发葡萄胎。DIFA是一种敏感性高、特异性强、操作简便适用于孕妇弓形虫感染初筛的好方法，为达到优生优育监测弓形虫感染的目的，而采用DIFA、IFT－IgG、Toxo－IgG／IgA／IgM联合测试是较好的方案。     

张家口地区医院病人弓形虫感染的血清流行病学调查

目的　了解张家口地区医院病人弓形虫感染情况 ,为临床提供一定的参考价值。方法　采用间接红细胞凝集试验对 5 83例住院病人进行弓形虫抗体检测。结果　张家口地区医院病人弓形虫抗体阳性率 10 .12 %。其中男性 11.0 1% ,女性9.0 6 % ,不同类型疾病弓形虫抗体阳性率明显不同 ,以系统性红斑狼疮、肿瘤患者较高 ,分别为 2 7.2 7% ,16 .92 %。结论　张家口地区医院病人弓形虫抗体阳性率 (10 .12 % )高于全国正常人群弓形虫抗体阳性率 (5 .17% ) ,不同类型疾病间阳性率明显不同 ,其中以系统性红斑狼疮、肿瘤患者较高。提示来医院就诊病人中可能有弓形虫病患者 ,免疫功能低下或受抑制患者易感染弓形虫病。     

恶性胸腔积液治疗指南摘要

发病率、病因与发病机制恶性胸腔积液 (MPE)在肿瘤患者中较为常见。因恶性肿瘤而死亡的患者中 ,15 %发生 MPE。MPE在渗出性积液中 4 2 %至 77%是由恶性疾病引起。几乎所有肿瘤均可侵犯胸膜腔 ,肺癌最常见 ,约占 MPE的1/ 3。乳癌居第二位。淋巴瘤 ,包括何杰金氏病和非何杰金氏淋巴瘤 ,卵巢和胃肠道的肿瘤较少引起 MPE。约 5 %～ 10 %的MPE找不到原发肿瘤。胸膜间皮瘤的发病与地域有关。尸检显示 ,多数胸膜腔转移来源于肿瘤栓子种植于脏层胸膜 ,其次种植于壁层胸膜。其他可能的转移机制包括肿瘤直接侵犯 (肺癌、乳癌、胸壁恶性肿瘤 )…     

ELISA检测白血病和淋巴瘤患者弓形虫抗体阳性率

ELISA检测贵州省白血病和淋巴瘤患者各150例血样中弓形虫特异性抗体(Ig G、Ig M)和循环抗原(CAg),计算阳性率。PCR扩增弓形虫529 bp特异性片段。结果显示,白血病患者弓形虫Ig G和Ig M抗体阳性率分别为16.0%(24/150)和2.7%(4/150),CAg阳性率为2.0%(3/150)。淋巴瘤患者弓形虫Ig G和Ig M抗体阳性率分别为20.0%(30/150)和1.3%(2/150),CAg阳性率为0.7%(1/150)。健康人Ig G和Ig M抗体阳性率分别为6.4%(7/110)和0.9%(1/110),CAg阳性率为0.9%(1/110)。白血病患者、淋巴瘤患者和健康人之间弓形虫Ig G抗体阳性率差异有统计学意义(P0.05),白血病和淋巴瘤患者间Ig G抗体阳性率差异无统计学意义(P0.05);弓形虫Ig M抗体和CAg阳性率在各组间差异均无统计学意义(P0.05)。白血病患者、淋巴瘤患者和健康人血样中均未扩增出529 bp特异性条带。     

先天性出生缺陷儿童弓形虫感染血清学调查

目的探讨儿童先天性出生缺陷与弓形虫感染的关系。方法应用弓形虫间接血球凝集试验(IHA)和弓形虫膜抗原酶联免疫吸附试验(ELISA)检测300例先天性出生缺陷儿童血清弓形虫抗体,并以35例因后天获得性外伤或车祸致残儿童作为对照。结果300例先天性出生缺陷儿童弓形虫抗体阳性66例,阳性率为22.00%;显著高于后天获得性外伤或车祸致残儿童的弓形虫抗体阳性率8.57%(χ2=3.54,P<0.05)。同时在66例弓形虫抗体阳性的先天性出生缺陷儿童家庭中,其父母至少有一方弓形虫抗体阳性的家庭达38户,占弓形虫抗体阳性的先天性出生缺陷儿童家庭的57.58%。结论弓形虫感染是儿童出生缺陷的重要因素之一,对优生优育夫妇积极开展弓形虫感染的血清学监测,将对提高人口素质、控制先天性弓形虫感染的发生具有重要意义。     

副肿瘤肾综合征

副肿瘤肾综合征(Paraneoplastic renal syndrome)是指肿瘤伴有肾脏病变而非肿瘤的肾转移,无肾静脉血栓形成和肾淀粉样变性者。Lee谓癌症患者伴有肾病综合征(NS)并非巧合。并谓恶性肿瘤中11%患者有肾病综合征。Plager复习1,643例NS而有恶性肿瘤者6例,600例何杰金氏病者中发生NS者4例。1977年Eagen等报告171例肿瘤并发肾小球病变,其中79例属淋巴系统恶性肿瘤,包括何杰金氏病63例,尚有非何杰金性恶性淋巴瘤,白血病,多发性骨髓瘤,及巨球蛋白血症;171例中67例系各种癌症,包括肺癌28例,结肠直肠癌7例,其他如胃癌,肾,宫颈,乳房,甲状     

ELISA IFAT和PCR/生物素探针检测中枢神经系统疾病中弓形虫感染

目的　比较 ELISA、IFAT和 PCR/生物素探针检测弓形虫感染的效果 ,了解中枢神经系统疾病中弓形虫感染的情况。方法　应用 EL ISA、IFAT和 PCR/生物素探针 (PCR-BP)对 164例脑囊虫病、10 8例疑似脑囊虫病、88例原发性癫痫患者和 115例健康人群进行了血清弓形虫抗体及血液中弓形虫特异序列 DNA检测和比较。结果　 ELISA和 IFAT检测各组人群抗弓形虫抗体阳性率分别为 15 .85 %、14 .81%、13 .64 %和 6.0 9% ,14 .0 2 %、14 .81%、14 .77%和 6.0 9%。PCR-BP检测各组弓形虫特异性 DNA阳性率分别为 2 .44 % (4 /164 )、3 .70 % (4 /10 8)、3 .41% (3 /88)、0 (0 /115 )。结论　 PCR/生物素探针适合诊断现症弓形虫感染 ,而 EL ISA和 IFAT可作为弓形虫感染的筛选方法。脑囊虫病、疑似脑囊虫病和原发性癫痫患者中存在弓形虫感染     

自体骨髓移植治疗成人恶性淋巴瘤后的长期随访

1983年至1991年我们用高剂量长春新碱、阿糖胞苷、环已亚硝脲及环磷酰胺加全淋巴(身)照射[Hd-VCCA+TL(B)I]和自体骨髓移植(ABMT)治疗了21例中高危组成人恶性淋巴瘤患者。其中5例为晚期,6例为耐药复发,4例为部分缓解(PR),4例为首次缓解(CR_1),2例为第二次缓解(CR_2)。平均随访37个月,9年生存率在何杰金氏淋巴瘤(HL)和非何杰金氏淋巴瘤(NHL)分别预期为89%和64%,提示该方案毒性反应可以耐受。如果在患者病程早期进行,可使约70%的成人恶性淋巴瘤患者长期存活。同时提示对骨髓受累或原淋巴细胞型的患者在移植前应作适当的净化残留肿瘤细胞的处理。     

长春地区孕产妇和肿瘤病人血清弓形虫抗体IgG的检测

目的 检测长春地区孕产妇和肿瘤病人弓形虫感染抗体IgG.方法 采用酶联免疫吸附试验对47例孕产妇和267例恶性肿瘤病人血清标本进行弓形虫抗体检测.结果 长春地区孕产妇和肿瘤病人血清弓形虫抗体IgG阳性率分别为10.64%和23.97%,显著高于健康人群阳性率6.08%(P＜0.05);鼻咽癌和直肠癌患者弓形虫抗体IgG阳性率高于其他类型肿瘤病人(P＜0.01).结论 孕产妇和肿瘤病人为弓形虫易感人群,应作常规性弓形虫抗体检测.     

恶性淋巴瘤心脏侵犯的临床病理研究

已有报道恶性淋巴瘤心脏转移,占整个恶性肿瘤的9%以上,而死于淋巴瘤的病人有20%发现心脏侵犯。由于心肌被肿瘤浸润的程度,心脏功能障碍的临床症状和体征可能不典型,而且心脏受侵犯在死前不易被发现。因此,对恶性淋巴瘤心脏侵犯的知识,大部分从尸体解剖中得来。本文报道1960～1980年150例经尸解的何杰金氏病(53例)或非何杰金氏淋巴瘤(97例),其中13例(8.7%)有淋巴瘤心脏或心包壁侵犯的组织学证据。     

抗独特型抗体对马来丝虫感染沙鼠的保护性免疫效果观察

目的 :研究抗丝虫抗独特型抗体 (抗 fil-抗 Id- Ab)对丝虫感染沙鼠的保护性免疫作用。方法 :从班氏丝虫病乳糜尿和鞘膜积液患者血清中分离含有高滴度的 Ig G,免疫家兔 ,获得兔抗 fil-抗 Id- Ig G,免疫沙鼠 ,再用马来丝虫感染期幼虫攻击 ,观察其免疫效果。结果 :抗 fil-抗 Id- Ig G一次脾内注射或多次皮下及腹腔内免疫后 ,50 %和 80 %沙鼠产生保护性免疫效果 ,沙鼠体内查不到微丝蚴和成虫 ,而从马来丝虫成虫可溶性抗原或兔抗正常人 Ig G为对照组的沙鼠中 ,80 %沙鼠感染丝虫 ,与正常感染组相近似。结论 :用抗 fil-抗 Id- Ab对马来丝虫感染沙鼠 ,证实有保护性免疫作用。     

Tuberculosis/toxoplasmosis co-infection in Egyptian patients:A reciprocal impact

Objective:To assess the concurrent toxoplasmosis infection in Egyptian TB patients and the impact of each infection on the other in terms of increased severity of TB or reactivation of latent Toxoplasma infection.Methods:Three hundred suspected pulmonary TB cases were initially screened for TB using direct Ziehl Neelsen staining and Lowenstein Jensen culture of their sputa.Rifampicin resistance was detected by Xpert MTB/RIF assay.Control group of 30 age and sex-matched healthy individuals negative for TB was included for comparison.All subjects were further assessed for serum levels of anti-Toxoplasma Ig G antibodies and malondialdehyde(MDA).Results:Forty three confirmed TB-infected patients including 10(23.3%)rifampicin-resistant patients were detected.Associated toxoplasmosis was found to be significantly higher among TB patients(OR=2.709;95%CI:1.034-7.099;P0.05)and among rifampicin sensitive than rifampicin resistant TB patients(OR=0.213;95%CI:0.048-0.951);P0.05).Serum levels of anti-Toxoplasma IgG antibodies and MDA were significantly higher among TB patients than the control group.Furthermore,serum level of MDA was significantly higher among TB/Toxoplasma co-infected patients as compared to toxoplasmosis free-TB patients.Strong positive correlation was detected between serum levels of anti-Toxoplasma Ig G and MDA in TB patients(r=0.75,P=0.001).Conclusions:Among pulmonary TB Egyptian patients,there is a considerable prevalence of toxoplasmosis.Severity of pulmonary tuberculosis could be increased by Toxoplasma co-infection.     

ELISA检测妇科肿瘤患者伴发弓形虫感染的调查

[目的 ]了解妇科宫颈癌患者伴发弓形虫感染的情况。[方法 ]采用 EL ISA法检测弓形虫 Ig G、Ig M抗体和循环抗原。 [结果 ]宫颈癌、妇科良性肿瘤、其它疾患妇女 3组人群的弓形虫感染率分别为 :44 .0 % (2 2 / 5 0 )、2 5 .4% (15 / 5 9)和 2 0 .3% (2 8/ 138)。 3组人群 Ig G阳性率分别为 2 0 .0 0 %、11.86 %和 10 .87% ,Ig M阳性率分别为2 0 .0 0 %、13.5 6 %和 8.70 % ,循环抗原阳性率分别为 14.0 0 %、5 .0 9%和 1.45 %。 [结论 ]宫颈癌患者弓形虫感染率明显高于其它两组人群 ,以循环抗原和 Ig M阳性尤为明显     

Hepatitis E in hemodialysis and kidney transplant patients in south-east Italy

AIM:To investigate the serovirological prevalence and clinical features of hepatitis E virus(HEV) infection in end-stage renal failure patients and in the healthy population.METHODS:HEV infection is a viral disease that can cause sporadic and epidemic hepatitis.Previous studies unexpectedly showed a high prevalence of HEV antibodies in immunosuppressed subjects,including hemodialysis(HD)patients and patients who had undergone kidney transplant.A cohort/case-control study was carried out from January 2012 to August 2013 in two hospitals in southern Italy(Foggia and S.Giovanni Rotondo,Apulia).The seroprevalence of HEV was determined in 801 subjects;231 HD patients,120 renal transplant recipients,and450 health individuals.All HD patients and the recipients of renal transplants were attending the Departments of Nephrology and Dialysis at two hospitals located in Southern Italy,and were included progressively in this study.Serum samples were tested for HEV antibodies(Ig G/Ig M);in the case of positivity they were confirmed by a Western blot assay and were also tested for HEV-RNA,and the HEV genotypes were determined.RESULTS:A total of 30/801(3.7%)patients were positive for anti-HEV Ig(Ig G and/or Ig M)and by Western blot.The healthy population presented with a prevalence of 2.7%,HD patients had a prevalence of 6.0%,and transplant recipients had a prevalence of 3.3%.The overall combined HEV-positive prevalence in the two groups with chronic renal failure was 5.1%.The rates of exposure to HEV(positivity of HEV-Ig G/M in the early samples)were lower in the healthy controls,but the difference among the three groups was not statistically significant(P>0.05).Positivity for anti-HEV/Ig M was detected in 4/30(13.33%)anti-HEV Ig positive individuals,in 2/14 HD patients,in1/4 transplant individuals,and in 1/12 of the healthy population.The relative risk of being HEV-Ig M-positive was significantly higher among transplant recipients compared to the other two groups(OR=65.4,95%CI:7.2-592.7,P<0.001),but the subjects with HEV-Ig M positivity were numerically too few to calculate a significant difference.No patient presented with chronic hepatitis from HEV infection alone.CONCLUSION:This study indicated a higher,but not significant,circulation of HEV in hemodialysis patients vs the healthy population.Chronic hepatitis due to the HEV virus was not observed.     

免疫缺陷性疾病患者弓形虫抗体的调查

[目的 ]调查免疫缺陷性疾病患者弓形虫IgG抗体的阳性率。 [方法 ]以酶联免疫吸附试验 (ELISA)检测临床多种免疫缺陷性疾病 ,包括实体性恶性肿瘤 (消化系统恶性肿瘤未化疗组、实体性恶性肿瘤未化疗组及实体性恶性肿瘤化疗组 )、慢性肝病、接受免疫抑制剂者 (皮肌炎、银屑病、天疱疮、肾移植术后、系统性红斑狼疮及其它使用免疫抑制剂者 )及血液系统恶性肿瘤 (淋巴瘤及白血病 )患者血清标本共 371份 ,同时以 10 0例健康人血清为对照。 [结果与结论 ]实体性恶性肿瘤接受化疗者、接受肾移植者、慢性肝病、系统性红斑狼疮及白血病患者抗弓形虫IgG抗体阳性率分别为 19 0 %、 33 3%、 16 5 %、 45 5 %及 2 0 0 % ,与对照组相比较 ,其差异均具有显著性意义 (P <0 0 5 )。以上疾病的患者有继发弓形虫病的高度危险。     

原头节抗原IFAT和IEST诊断人体包虫病的比较研究

以冰冻保存的绵羊棘球蚴内原头节为抗原作间接荧光抗体试验(IFAT)和间接免疫酶染色试验(IEST),检测对包虫病人、非包虫病人及键康人的敏感性、特异性及交叉反应性,并与间接血凝试验相比较(IHAT)。结果表明IFAT的敏感性和特异性分别为90.36％和97.67％;IEST的敏感性和特异性分别为96.55％和100.0％;两种方法均高于IHAT的敏感性(85.54％)和特异性(95.35％)。三种方法对血吸虫感染者和癌症病人血清均无交叉反应,但对囊虫病人的交叉反应率为IFAT(51.35％)>IHAT(37.84％)>IEST(21.62％)。以原头节为抗原IEST诊断人体包虫病敏感性高、特异性强,适用范围广,不需特殊设备,具有现场应用价值。     

Viral hepatitis prevalence in patients with active and latent tuberculosis

AIM: To assess the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and association with drug induced liver injury(DILI) in patients undergoing anti-tuberculosis(TB) therapy.METHODS: Four hundred and twenty nine patients with newly diagnosed TB- either active disease or latent infection- who were due to commence antiTB therapy between September 2008 and May 2011 were included. These patients were prospectively tested for serological markers of HBV, HCV and human immunodeficiency virus(HIV) infections- hepatitis B core antigen(HBc Ag), hepatitis B surface antigen(HBs Ag), hepatitis B e antigen, Ig G and Ig M antibody to HBc Ag(anti-HBc), HCV Ig G antibody and HIV antibody using a combination of enzyme-linked immunosorbent assay, Western blot assay and polymerase chain reaction techniques. Patients were reviewed at least monthly during the TB treatment initiation phase. Liver function tests were measured prior to commencement of antiTB therapy and 2-4 wk later. Liver function tests were also performed at any time the patient had significant nausea, vomiting, rash, or felt non-specifically unwell. Fisher's exact test was used to measure significance in comparisons of proportions between groups. A P value of less than 0.05 was considered statistically significant.RESULTS: Of the 429 patients, 270(62.9%) had active TB disease and 159(37.1%) had latent TB infection. 61(14.2%) patients had isolated anti-HBc positivity, 11(2.6%) were also HBs Ag positive and 7(1.6%) were HCV-antibody positive. 16/270 patients with active TB disease compared to 2/159 patients with latent TB infection had markers of chronic viral hepatitis(HBs Ag or HCV antibody positive; P = 0.023). Similarly the proportion of HBs Ag positive patients were significantly greater in the active vs latent TB infection group(10/43 vs 1/29, P = 0.04). The prevalence of chronic HBV or HCV was significantly higher than the estimated United Kingdom prevalence of 0.3% for each. We found no association between DILI and presence of serological markers of HBV or HCV. Three(5.3%) patients with serological markers of HBV or HCV infection had DILI compared to 25(9.5%) patients without; P = 0.04.CONCLUSION: Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.     

Tumor necrosis factor gene polymorphisms and clearance or progression of hepatitis B virus infection.

OBJECTIVES: We evaluated the influence of tumor necrosis factor-alpha (TNF-alpha) promoter gene polymorphisms on clearance of hepatitis B virus (HBV) and outcome of HBV chronic hepatitis. METHODS: Four TNF-alpha promoter polymorphisms (T-1031C, C-863A, G-308A, and G-238A) were evaluated by direct sequencing in 184 chronic HBV carriers hepatitis B surface antigen (HBsAg) positive and 96 controls with documented sero-clearance (HBsAg negativity, positivity for anti-HBs and anti-HBc IgG). Frequencies of single-nucleotide polymorphisms (SNPs) and haplotypes in the control group were compared with those of the chronic carrier group and with clinically defined subgroups of the latter: asymptomatic carriers, patients with compensated hepatitis, decompensated cirrhotics, and patients with hepatocellular carcinoma. Furthermore, subgroups of chronic carriers were compared among them. Results: In the chronic carrier group, the -308 G allele was more frequent in those with a family history of HBV infection (96% vs 88% of those with non-familial transmission). The G/G genotype at position -308 was found in all chronic carriers with decompensated cirrhosis but in only 78% of controls (P=0.01) and was more frequent in decompensated cirrhotics than in the other subgroups. The distribution of TNF-alpha gene polymorphisms in the carrier group was not significantly different from that in the sero-clearance control group. TNF-alpha SNPs at positions -1031/-863 and -863/-238 were in linkage disequilibrium. The TCGG haplotype (-T1031, -C863, -G308, -G238) was significantly associated with end-stage liver disease. CONCLUSION: The TNF-alpha promoter polymorphisms do not appear to be determinant of HBV sero-clearance in southern Italians. The genotype -308G/G and haplotype TCGG are associated with an unfavorable prognosis in patients with chronic HBV infection.     

Impact of pathogen burden in patients with coronary artery disease in relation to systemic inflammation and variation in genes encoding cytokines

The number of infectious pathogens to which an individual has been exposed (pathogen burden) has been linked to the development and the prognosis of coronary artery disease (CAD). The interaction among infection, genetic host susceptibility, and CAD remains unclear. This study was aimed at evaluating the modulation of the association between CAD and pathogen burden, by serum levels of inflammatory markers and polymorphisms of the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha genes. Immmunoglobulin (Ig) G or IgA antibodies to 8 pathogens were determined in 991 patients with CAD and 333 control subjects. Serum levels of high-sensitivity C-reactive protein, fibrinogen, IL-6, and TNF-alpha were also measured. All subjects were genotyped for the IL-6/G-174C, the TNF/C-851T, and the TNF/G-308A polymorphisms. Analysis of single pathogens demonstrated a positive relation to the presence of CAD for some (Chlamydia pneumoniae, cytomegalovirus, Helicobacter pylori, and herpes virus simplex type 1), but not all pathogens. A strong association between increasing pathogen burden and CAD was confirmed, even after adjustment for risk factors. The prevalence of a high pathogen burden (>/=4 pathogens) was 50% in patients and 21% in controls (p <0.0001). A high pathogen burden was associated with decreased high-density lipoprotein cholesterol levels (p <0.001). The association between CAD and pathogen burden was modulated by the IL6/G-174C polymorphism, the odds ratio being higher in heterozygotes than in both types of homozygotes (p <0.05). This interaction appeared to be mediated by variations in serum IL-6 levels. No such interaction was detected with any of the 2 TNF-alpha polymorphisms.