以重组人巨细胞病毒pp65制备的多克隆抗体建立检测感染性病毒颗粒方法

人巨细胞病毒(HCMV)活动性感染是造成器官移植失败的重要原因。建立灵敏、特异的检测方法可为及早发现感染、及时给予抗病毒治疗提供依据。以离子交换和分子筛方法纯化重组表达的HCMVpp65(rp65hp)抗原,经两步纯化后,rp65hp纯度达到95%。免疫家兔制备的抗血清,ELISA抗体滴度高达1∶2560000;免疫印迹证明能与HCMVpp65抗原特异反应。将HCMV病毒感染细胞,以纯化的多克隆抗体建立了间接免疫荧光法,成功地检测到细胞中的病毒。因此,该方法为临床检测HCMV病毒活动性感染奠定了良好的基础。     

人巨细胞病毒pp65蛋白的原核表达及活性鉴定

以病毒全基因组为模板,通过PCR技术扩增HCMV pp65基因编码序列,其产物连接到pMD18-T质粒,酶切并回收目的片段后克隆到表达载体pTO-T7,然后将重组质粒pTO-T7-pp65转化大肠杆菌ER2566,大量表达后将重组蛋白进行质谱法分析鉴定,再利用Western blot以及间接ELISA进行重组蛋白的活性及抗原性鉴定.结果显示:通过SDS-PAGE鉴定可知,大肠杆菌可能表达出了重组蛋白,质谱分析结果说明了重组蛋白为pp65蛋白,具有极高可信度,其相对分子质量约为63 kD,从Western blot和间接ELISA(enzyme linked immunosorbent assay)的结果可知,pp65蛋白作为抗原具有良好的免疫反应性与免疫原性,为制备相应的抗原诊断单克隆抗体打下了基础,同时也为开发HCMV IgG快速诊断ELISA试剂盒提供了可选原料.     

流式细胞术检测人巨细胞病毒活动性感染检测方法的建立及检测效果评价

探讨流式细胞术检测人巨细胞病毒活动性感染检测方法的可行性及效果评价。分离人外周血白细胞,以商品化的小鼠抗人巨细胞病毒pp65抗原单克隆抗体为一抗,FITC标记的羊抗小鼠IgG抗体为二抗,采用流式细胞术对外周血人巨细胞病毒pp65抗原进行检测。同时采用间接免疫荧光法对外周血人巨细胞病毒pp65抗原进行检测。采用配对χ2检验对两种方法的检测效果进行评价。临床送检的65份疑似为人巨细胞病毒感染病人外周血标本中,间接免疫荧光法检出阳性9份,流式细胞术检出阳性11份,两种方法阳性检出率差异无统计学意义(P0.05)。采用流式细胞术可定量检测外周血人巨细胞病毒pp65抗原,与间接免疫荧光法检测结果无统计学差异,可在临床推广使用。     

人巨细胞病毒cDNA文库的构建、鉴定及pp65阳性克隆筛选

为进一步进行人巨细胞病毒 (HCMV)后基因组功能的研究 ,以及为疫苗分子和早期诊断试剂的研制提供有效工具 ,从HCMVAD1 69株感染 96h的HF细胞中提取HCMV的mRNA ,逆转录合成cDNA片段 ,重组入λgt1 1EcoRI酶切位点之间 ,包装蛋白包装 ,构建HCMVAD1 69株基因组cDNA表达文库。结果表明 ,初始HCMVcDNA文库容量为 3 6× 1 0 6,重组率为 96% ;HCMV鼠多克隆抗血清筛选出 1 68个HCMV阳性克隆 ;地高辛标记pp65特异性寡核苷酸探针原位噬斑杂交筛选出 3 4个pp65阳性克隆 ,再经PCR扩增 ,筛选出 2个pp65阳性克隆 ;pp65PCR扩增产物进一步被Southernblotting证实 ;3 端测序比较 ,同源性为 98%。为进一步克隆、表达该基因及其产物功能研究奠定基础     

应用复合增强剂扩增人巨细胞病毒pp65全基因

在PCR过程中 ,模板GC含量过高是一个不利因素。如果设计扩增片段较长 ,则进一步增加了PCR扩增的难度。解决这一问题对于以PCR成功获取富含GC的长基因有非常重要的意义。以人巨细胞病毒pp65全基因 (约 1 95 0bp ,GC %为 67%)为例 ,在PCR系统中测试不同添加剂(甘油、乙醇、DMSO、甜菜碱等 )及各种组合 ,摸索扩增目的基因的最佳条件。结果发现 :无或单一的添加剂都不能获得目的基因片段 ,只有当同时使用DMSO和甜菜碱 ,并在适当浓度时才能够获得特异产物。在PCR系统中包含复合增强剂能有助于高GC %、长基因片段的扩增 ,为解决此类问题提供了一种有效的途径。     

人巨细胞病毒gp52蛋白与pp65蛋白融合表达及初步应用

建立以重组表达HCMV蛋白为抗原的检测试剂盒,提高试剂盒的敏感性及特异性。从病毒及质粒中分别扩增gp52（281～433aa,f1）及pp65（361～473aa,f2）2个片段,以不同酶切位点同时插入到pTrcHisB载体上,筛选正确的重组质粒并在大肠杆菌中诱导表达。表达蛋白rp52～65占菌体总蛋白的30％,以包涵体的形式存在,分子量为35000.以金属螯合亲和层析（IMAC）及分子筛方法纯化表达蛋白,纯度达到96％,得率为22．9％。以间接法检测HCMVIgM阳性血清,敏感性达到90．4％（19／21）。融合蛋白具有良好的抗原性,可代替gp52及pp65作为HCMVIgM抗体检测试剂盒的包被抗原。     

巨细胞病毒早期抗原pp65和晚期抗原pp67-mRNA在移植术后活动性巨细胞病毒感染诊断中的价值

目的：通过对器官移植术后受者外周血中巨细胞病毒（CMV）早期抗原pp65和晚期抗原pp67-mRNA的监测,评价其对于诊断器官移植术后CMV感染、发病及预后的价值,为临床准确有效地分析理解检测结果提供依据。方法：收集28例器官移植受者EDTA抗凝外周血标本共120份,用免疫荧光技术（IFA）检测其中CMV早期抗原pp65;用核酸基础序列扩增法（NASBA）测定晚期CMVpp67-mRNA,绘制2组用于诊断CMV的受试者特征曲线（ROC曲线）,比较2组曲线下面积。结果1120份样本中,42份为CMVpp65阳性（≥1个阳性细胞／2×105白细胞）,23份为CMVpp67-mRNA阳性。28例器官移植受者中,9例CMVpp65和pp67-mRNA均为阳性（其中3例pp65和pp67-mRNA在同一时间为阳性）,8例pp65为阳性而pp67-mRNA为阴性,2例pp65为阴性而pp67-mRNA为阳性。临床诊断感染CMV的患者4例,在感染早期无临床症状病毒潜伏期间,受试者工作特征（ROC）曲线下面积（AUC）pp65为0．9542,pp67-mRNA为0．6611,即pp65检测的灵敏度和特异性高于pp67-mRNA;而在出现临床症状并治疗后期,pp65的AUC为0．8300,pp67-mRNA为0．9232,pp67-mRNA的灵敏度和特异性高于pp65。根据ROC曲线查得,以每2x105白细胞中有10个阳性细胞为诊断CMV活动性感染的最佳临界值。结论：AUC结果表明,pp65、pp67-mRNA均具有诊断意义。pp65检测更适于早期CMV活动性诊断,对于提示临床开始抗病毒治疗具有早期快速的意义;pp67-mRNA检测快速、结果准确,可作为结束抗病毒治疗的参考指标;两者联合检测用于监测CMV,对于辅助临床诊断有很好的价值。     

检测巨细胞病毒(CMV)DNA及其即刻早期抗原、pp65和pp67在肾移植受者术后巨细胞病毒感染早期诊断中的价值

目的探讨检测巨细胞病毒(CMV)DNA及其即刻早期抗原(IE)、巨细胞病毒pp65和pp67抗体对肾移植受者术后巨细胞病毒感染早期诊断的临床应用价值。方法按肾移植术受者术后3个月外周血是否出现CMV抗原,将71例患者分为CMV感染组(56例)和CMV未感染组(15例),肾移植术受者手术前和术后第1个月每周检查1次,第2、3个月每2周检查1次外周血巨细胞病毒pp65和巨细胞病毒pp67、即刻早期抗原(immediate early antigen,IE),巨细胞病毒DNA和IgM、IgG,共8次;以监测与分析评价肾移植术受者手术前后各项指标变化。结果肾移植术前71例肾移植受者PP65、PP67、IE、CMV DNA均为阴性;肾移植术后CMV感染组的pp65、pp67、IE、CMV DNA阳性率分别为67.8%(38/56)、66.1%(37/56)、64.2%(36/56)和48.2%(27/56),CMV未感染组4项指标值分别为0%、0%、13.3%(2/15)、和0%,两组差异均有统计学意义(P均0.01)。肾移植术后CMV感染组(56例)和CMV未感染组(15例)CMV IgG均为阳性,而IgM阳性率在CMV感染组仅为3.5%(2/56),在CMV未感染组为0%,IgM表达率在CMV感染组和未感染组无统计学差异(P0.05)。观察期内感染组与未感染组相比,术后CMV pp65,pp67,CMV DNA和IE指标出现阳性的例数及阳性出现的具体时间均有显著性差别(P均0.01),而IgM和IgG则均无显著性差别(P均0.05)。结论肾移植术后患者外周血CMV DNA,IE,pp65和pp67抗原检测阳性与其术后巨细胞病毒感染相关。检测CMV DNA、IE、pp65和pp67抗原可能更早更准确反映器官移植术后CMV活动性感染。而CMV IgG和IgM不能作为肾移植后患者CMV感染的诊断指标。     

肾移植术后巨细胞病毒感染的诊治进展

肾移植术后长期大量的使用免疫抑制药物,使患者的细胞免疫、体液免疫均受损,特别是细胞免疫受损更为严重,因而增加了各种感染的机会.感染时间以术后2～4月多见.感染病原茵有细菌、病毒、真菌及卡氏肺囊虫等,常常为混合感染.其中病毒感染以巨细胞病毒(cytomegalovirus,CMV)多见,且CMV感染是降低受者和移植肾存活率的重要因素.本文就肾移植术后巨细胞病毒感染的诊治作一综述.     

人巨细胞病毒IgG抗体(ELISA)检测试剂盒稳定性观察

目的观察人巨细胞病毒(human cytomegalovirus,HCMV)IgG抗体(ELISA)检测试剂盒的稳定性。方法将HCMV IgG抗体(ELISA)检测试剂盒分别以不同时间放置于2~8℃和37℃,检测试剂盒的外观、阳性参考品符合率、阴性参考品符合率、重复性和检测限,并对其进行稳定性(实时稳定性、加速破坏稳定性、开瓶稳定性、运输稳定性)的观察及初步应用。结果 3批实验用试剂盒实时稳定性和3批试生产试剂盒加速破坏稳定性、开瓶稳定性、运输稳定性试验中,外观均合格,阴性参考品符合率及阳性参考品符合率均为100%,最低检出限参考品均能检出。3批实验用试剂盒实时稳定性检测重复性良好,CV值均≤15.00%。3批试生产试剂盒在37℃条件下放置6 d后,CV值分别为7.94%、7.16%、4.66%;开瓶后分别置于2~8℃冰箱0w、1w、2w、3w、4w,CV值均≤1 5.00%;运输至上海,CV值分别为2.59%、3.12%、2.37%;运输至海南,CV值分别为4.89%、2.65%、2.33%。样品反复冻融5次后,试剂盒检测稳定性良好。结论 HCMV IgG抗体(ELISA)检测试剂盒具有良好的稳定性,在2~8℃条件下至少可保存15个月。     

肝移植后播散性隐球菌病1例及其实验研究

目的播散性隐球菌病临床及实验研究。方法患者女,47岁,肝移植术后2 d,面部、肩部、四肢皮肤出现多发溃疡,伴昏迷。通过脑计算机断层扫描、皮损组织病理检查、PAS染色、皮损组织真菌培养及激光俘获显微切割结合PCR扩增序列分析确诊,并对获得菌株进行尿素酶试验、API试验、PCR扩增测序等实验研究。结果皮损组织病理可见大量圆形和椭圆形菌体,PAS染色阳性。血液和脑脊液真菌镜检均为阴性。皮损组织真菌培养可见酵母样菌落生长,菌株尿素酶试验阳性,API试验鉴定为新生隐球菌。ITS区序列分析鉴定为新生隐球菌grub ii变种。激光俘获显微切割结合PCR扩增,序列分析与培养获得的菌株直接PCR扩增后序列分析结果一致。脑脊液特异性隐球菌抗原（＋＋）,血液特异性隐球菌抗原（＋＋＋＋）。脑CT显示为多发结节灶。依据临床及实验室检查确诊为播散性隐球菌病,致病菌为新生隐球菌grubii变种。结论通过对该病例的深入研究,为临床明确诊断播散性隐球菌病奠定基础,确立了显微切割技术在皮肤真菌感染中的应用价值。     

The presence of antibodies against the AD2 epitope of cytomegalovirus glycoprotein B is associated with acute rejection after renal transplantation

The aim of this study was to evaluate the association between antibodies against cytomegalovirus (CMV) glycoprotein B (gB) and acute rejection after transplantation. Seventy‐seven consecutive renal transplant recipients in a D + /R+ setting were studied. Biopsy‐proven rejection occurred in 35% of the recipients. Among these recipients, 85% had antibodies against CMV gB. The rate of acute rejection was significantly higher in recipients with antibodies against gB than in those without them. Antibodies against gB can be a useful predictor of acute rejection in renal transplant recipients in a D + /R+ setting.     

Up-regulation of PRKDC was associated with poor renal dysfunction after renal transplantation: A multi-centre analysis

Renal transplantation is the only efficacious treatment for end-stage kidney disease. However, some people have developed renal insufficiency after transplantation, the mechanisms of which have not been well clarified. Previous studies have focused on patient factors, while the effect of gene expression in the donor kidney on post-transplant renal function has been less studied. Donor kidney clinical data and mRNA expression status were extracted from the GEO database (GSE147451). Weight gene co-expression network analysis (WGCNA) and differential gene enrichment analysis were performed. For external validation, we collected data from 122 patients who accepted renal transplantation at several hospitals and measured the level of target genes by qPCR. This study included 192 patients from the GEO data set, and 13 co-expressed genes were confirmed by WGCNA and differential gene enrichment analysis. Then, the PPI network contained 17 edges as well as 12 nodes, and four central genes (PRKDC, RFC5, RFC3 and RBM14) were identified. We found by collecting data from 122 patients who underwent renal transplantation in several hospitals and by multivariate logistic regression that acute graft-versus-host disease postoperative infection, PRKDC [Hazard Ratio (HR) = 4.44; 95% CI = [1.60, 13.68]; p = 0.006] mRNA level correlated with the renal function after transplantation. The prediction model constructed had good predictive accuracy (C-index = 0.886). Elevated levels of donor kidney PRKDC are associated with renal dysfunction after transplantation. The prediction model of renal function status for post-transplant recipients based on PRKDC has good predictive accuracy and clinical application.     

冻融小鼠卵巢移植后细胞凋亡及血管内皮生长因子表达的变化及意义研究

目的:探讨冻融小鼠卵巢同种异体移植后细胞凋亡及血管内皮生长因子表达的变化及意义。方法:收集C57BL/6j雌鼠和BALB/c雄鼠杂交后F1代4周龄小鼠卵巢,慢冻速融后移植至杂交后F1代8～12周雄鼠的肾被膜下,分别于移植后1d(24h)、2d(48h)和7d回收移植物,将冻融以及移植后不同时间段的卵巢组织进行HE染色、全卵巢卵泡计数、电镜观察、免疫组织化学分析细胞凋亡及RT-PCR检测VEGF基因表达。结果:冻融小鼠卵巢移植后随着时间的推移、各级卵泡数和卵泡存活率逐渐下降;移植后48h内细胞凋亡指数最高;电镜观察发现小鼠卵巢组织移植后损伤主要发生在移植后48h内;移植后VEGF的表达有上升的趋势,至第7d仍维持较高水平;移植后48hVEGF120mRNA和VEGF188mRNA水平明显升高(P0.05),至7d下降恢复至移植前水平,而VEGF164mRNA水平移植后无明显变化(P0.05)。结论:小鼠卵巢组织移植后48h内细胞凋亡最为严重,移植后引起大量卵泡的丢失;在移植后血管化的过程中VEGFmRNA表达量增加,VEGF120mRNA和VEGF188mRNA可能参与卵巢移植后早期血管化过程。     

Ultrasound detection of non-Hodgkin's lymphoma in three cynomolgus monkeys after renal transplantation and cyclosporine immunosuppression

PURPOSE: To describe the early detection of non-Hodgkin's lymphoma (NHL) with ultrasound in three clinically normal cynomolgus monkeys post-renal transplantation and immunosuppression with cyclosporine. MATERIALS AND METHODS: The monkeys in this report were treated with cyclosporine (Neoral) after receiving renal transplants. In addition to clinical and laboratory (hematology, serum chemistry) monitoring, renal allografts were monitored every 2 weeks with ultrasound and ultrasound-guided allograft biopsies were performed. RESULTS: Enlarged renal hilar and mesenteric lymph nodes were detected with ultrasound in three monkeys on days 36, 49 and 134 post-transplantation. Sonographically the lymph nodes were inhomogeneous, of low echogenity and rounded. In two animals, the spleen was sonographically enlarged and inhomogeneous. All three monkeys were symptom-free at the time of ultrasound detection and NHL was diagnosed histologically. CONCLUSION: Ultrasound provides a rapid, non-invasive means of early detection of NHL in animal transplantation models prior to the onset of clinical symptoms of disease.     

Histological,molecular and biochemical detection of renal injury after Echis pyramidum snake envenomation in rats

Nephrotoxicity is a common sign of snake envenomation. The present work aimed to clarify the effect of intraperitoneal injection of 1/8 LD₅₀ and 1/4 LD₅₀ doses of Echis pyramidum snake venom on the renal tissue of rats after 2, 4 and 6 h from envenomation. Histopathological examination showed intense dose and time dependent abnormalities, including swelling glomerulus and tubular necrosis and damage as well as signs of intertubular medullary hemorrhage at early stages of envenomation. However, at late stages of envenomation by any of the doses under investigation, no intact renal corpuscles were recorded and complete lysis in renal corpuscles with ruptured Bowman’s capsules was observed. Immunohistochemistry by immunohistochemical staining was used to test the protein expression of Bax in renal tissue of rats. The result showed that the expression of Bax in renal tissue sections of envenomated rats was increased according to dose and time-dependant manner. The isolation of DNA from the renal cells of envenomed rats pointed out to the occurrence of DNA fragmentation, which is another indicator for renal tissue injury especially after 6 h of 1/4 LD₅₀ of E. pyramidum envenomation. Oxidative stress biomarkers malondialdehyde and nitrite/nitrate levels, antioxidant parameters; glutathione, total antioxidant capacity and catalase were assayed in renal tissue homogenates. The venom induced significant increase in the levels of malondialdehyde and nitrite/nitrate while the levels of glutathione, total antioxidant capacity and catalase were significantly decreased, especially after 6 h of envenomation. The results revealed that the E. pyramidum induced dose and time-dependant significant disturbances in the physiological parameters in the kidney. We conclude that the use of the immunohistochemical techniques, the detection of DNA integrity and oxidative stress marker estimations are more specific tools that can clarify cellular injury and could point out to the defense activity of the renal tissue at envenomation.     

异基因造血干细胞移植后激素耐药胃肠道急性移植物抗宿主病的临床分析

目的探讨异基因造血干细胞移植后激素耐药胃肠道急性移植物抗宿主病(aGVHD)的影响因素。方法回顾性分析西安交通大学第一附属医院2012年1月至2019年12月期间行异基因造血干细胞移植,术后发生胃肠道aGVHD 20例患者的临床资料。按照一线糖皮质激素治疗后的反应分为激素敏感组(13例)和激素耐药组(7例)。单因素Logistics回归分析患者性别、年龄、诊断、移植前微小残留病灶、移植类型、供者年龄、供受者关系、供受者ABO血型、输注单个核细胞数、CD34+细胞数、CD3+细胞数、中性粒细胞及血小板植入时间、CMV及EB病毒感染、胃肠道aGVHD发生的时间等与激素耐药胃肠道aGVHD的关系。观察激素耐药患者治疗后的转归,采用Kaplan-Meier生存分析激素耐药及敏感患者的预后差异。结果20例胃肠道aGVHD患者中7例存在激素耐药。胃肠道GVHD发生时间<1个月,激素耐药的风险增加(OR=13.500,95﹪CI=1.197~152.211,P=0.035),患者性别、年龄、诊断、移植前MRD、移植类型、供者年龄、供受者关系、供受者ABO血型、输注的单个核细胞、CD34+细胞、CD3+细胞、中性粒细胞和血小板植入时间、CMV和EB病毒感染均不影响激素耐药(P>0.05)。7例激素耐药胃肠道aGVHD患者均接受二线CD25单克隆抗体治疗,治疗后5例有效,2例无效死亡。与激素敏感组比较,激素耐药组患者1年总生存率(64﹪比52﹪)降低及无进展生存率(28﹪比32﹪)升高,差异无统计学意义(P>0.05)。结论异基因造血干细胞移植后胃肠道aGVHD激素耐药可能与其发生时间相关,发生时间越早,越容易出现激素耐药。     

慢性肾小球肾炎患者治疗前后血清CRP和VEGF浓度变化及临床意义

目的:研究慢性肾小球肾炎(CNG)中血清C反应蛋白(CRP)和血管内皮生长因子(VEGF)的浓度变化及其临床意义。方法:采用ELISA法测定35例正常对照组与41例慢性肾小球肾炎患者治疗前后血清IL-6和VEGF的浓度,同时放射免疫分析法测定血清TNF-α浓度,免疫比浊法测定血清CRP与尿Alb浓度。结果:①治疗前后CNG患者血清中IL-6、TNF-α和CRP较正常对照组均显著升高(P<0.05或P<0.01),但治疗后IL-6、TNF-α和CRP水平显著低于治疗前(P<0.01),且血清CRP与IL-6和TNF-α呈正相关(P<0.01)。②治疗后,CNG患者血清VEGF水平与尿Alb含量较治疗前明显降低(P<0.05或P<0.01),仍显著高于正常对照组(P<0.05或P<0.01),且血清VEGF与尿Alb水平呈正相关(P<0.01)。结论:CRP、IL-6和TNF-α参与了CNG患者慢性炎症反应,VEGF则与蛋白尿的产生密切相关,治疗前后血清CRP和VEGF检测对于慢性肾小球肾炎的病情了解及临床疗效评估均具有重要的临床价值。     

慢性肾小球肾炎患者治疗前后血清CRP和VEGF浓度变化及临床意义

目的：研究慢性肾小球肾炎（CNG）中血清C反应蛋白（CRP）和血管内皮生长因子（VEGF）的浓度变化及其临床意义。方法：采用ELISA法测定35例正常对照组与41例慢性肾小球肾炎患者治疗前后血清IL-6和VEGF的浓度,同时放射免疫分析法测定血清TNF-α浓度,免疫比浊法测定血清CRP与尿Alb浓度。结果：①治疗前后CNG患者血清中IL-6、TNF-α和CRP较正常对照组均显著升高（P〈0.05或P〈0.01）,但治疗后IL-6、TNF-α和CRP水平显著低于治疗前（P〈0.01）,且血清CRP与IL-6和TNF-α呈正相关（P〈0.01）。②治疗后,CNG患者血清VEGF水平与尿Alb含量较治疗前明显降低（P〈0.05或P〈0.01）,仍显著高于正常对照组（P〈0.05或P〈0.01）,且血清VEGF与尿Alb水平呈正相关（P〈0.01）。结论：CRP、IL-6和TNF-α参与了CNG患者慢性炎症反应,VEGF则与蛋白尿的产生密切相关,治疗前后血清CRP和VEGF检测对于慢性肾小球肾炎的病情了解及临床疗效评估均具有重要的临床价值。