1-3-β-D葡聚糖和半乳甘露聚糖检测在早期诊断腹膜透析相关真菌性腹膜炎中的价值分析

目的分析1-3-β-D-葡聚糖(1-3-β-D glucan,BG)和半乳甘露聚糖(galactomannan,GM)检测在早期诊断腹膜透析相关真菌性腹膜炎中的临床应用价值。方法回顾性分析陆军特色医学中心肾内科2008年1月~2019年1月持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)明确诊断腹膜炎的患者,纳入完善了血清BG和GM检测的患者63例,腹水培养有真菌的患者22例,培养为细菌的患者41例,对照组11例。共纳入分析74例,其中男性38例,女性36例,平均年龄(50.65±13.31)岁,平均透析龄(37.08±25.01)月。血清BG和/或GM检测大于临界值,立即联合使用氟康唑或伏立康唑抗感染治疗,收集入院至起始抗真菌治疗时间、住院时间、90天生存情况。采用4格表评价BG检测、GM检测及二者联合检测对真菌性腹膜炎的诊断效能。结果BG和GM检测对真菌性腹膜炎的诊断灵敏度、特异度、阳性预测值和阴性预测值分别为:86.4%,95.1%,90.5%,92.9%和36.4%,92.7%,72.7%,73.1%。联合检测诊断灵敏度达到95.5%,特异度达97.6%。联合检测组入院至起始抗真菌治疗时间短于对照组(t=12.751,P<0.001),联合检测组平均住院时间短于对照组(t=3.649,P=0.001)。联合检测组90天生存率显著高于对照组(χ^(2)=5.515,P=0.019)。结论BG、GM联合检测可以早期诊断真菌性腹膜炎,且有较高的灵敏度和特异度,为疾病的治疗提供有力的依据,改善患者预后及降低病死率。

回族中小学生95名血浆甘露糖结合凝集素含量

目的 检测北方地区健康回族中小学生血浆甘露糖结合凝集素 (MBL)的浓度 ,评价其非特异性免疫功能。方法 用EDTA -Na2 抗凝法分离血浆 ,采用ELISA法对 95名中小学生进行检测。结果 小学生血浆MBL的含量为 (3 .2 59± 2 .550 )mg/L ,中学生为 (4.1 92±2 .554)mg/L ,差异无统计学意义 (t=1 .461 ,P >0 .0 5) ;女生血浆MBL的含量为 (3.433± 2 .567)mg/L ,男生为 (3 .850± 2 .567)mg/L ,女生略低于男生 ,但差异无统计学意义 (t=0 .67,P >0 .0 5)。结论 血浆MBL含量在北方地区男女中小学生中处于相对一致的水平。

Partial overlap of anti-mycobacterial,and anti-Saccharomyces cerevisiae mannan antibodies in Crohn's disease

AIM： To test whether humoral immune reaction against mycobacteria may play a role in anti- Saccharomyces cerevisiae antibodies （ASCA） generation in Crohn＇s disease （CD） and/or whether it correlates with clinical subtypes. METHODS： The dominant ASCA epitope was detected by Galanthus nivalis lectin （GNL）-binding assay. ASCA and IgG against mycobacterial lysates （M avium, M smegmatis, M chelonae, M bovis BCG M avium ssp. paratuberculosis （MAP）] or purified lipoarabinomannans （LAM） were detected by ELISA. ASCA and anti-mycobacterial antibodies were affinity purified to assess cross-reactivities. Anti-mycobacterial IgG were induced by BCG-infection of mice. RESULTS： GNL bound to different extents to mycobacterial lysates, abundantly to purified mannosecapped （Man） LAM from M tuberculosis, but not to uncapped LAM from M srnegrnatis. Fifteen to 45% of CD patients but only 0%-6% of controls were seropositive against different mycobacterial antigens. Anti-mycobacterial IgG correlated with ASCA （r = 0.37-0.64; P = 0.003-P 〈 0.001）. ASCA-positivity and deficiency for mannan-binding lectin synergistically associated with anti-mycobacterial IgG. In some patients, anti-mycobacterial antibodies represent crossreactive ASCA. Vice-versa, the predominant fraction of ASCA did not cross-react with mycobacteria. Finally, fistulizing disease associated with antibodies against M avium, M smegmatis and MAP （P = 0.024, 0.004 and 0.045, respectively）. CONCLUSION： Similar to ASCA, seroreactivity against mycobacteria may define CD patients with complicated disease and a predisposition for immune responses against ubiquitous antigens. While in some patients anti-mycobacterial antibodies strongly cross-react with yeast mannan; these cross-reactive antibodies only represent a minor fraction of total ASCA. Thus, mycobacterial infection unlikely plays a role in ASCA induction.