1、HFRS患者特異性IgA、IgE抗體及其免疫復合物測定摘要為進一步研究hfrs免疫損傷機制，用elisa法同步測定了108例差異臨床型、差異病日、病期hfrs患者血清中特異性iga、ige抗體以及hfrs病毒特異性iga、ige型i的程度及檢出率。創(chuàng)造hfrs-iga型抗體在輕型病例高于中、重型病例；hfrs-ige型抗體及ige型i在重型病例高于中、輕型病例。上述差異在病程早期(發(fā)熱、休克少尿期，或是38病日)尤為突出。iga型i那么未見到上述差異。studiesndetetinfseruspeifiiga,igeantibdiesandirulatiniuneplexesinpatient

2、sfherrhagifeverithrenalsyndrezhangdnghaisunhuigafeng(zibsendhealthshl)abstratdetetinhadbeenadefrthelevelsfseruspeifiityiga,igeantibdieandspeifiityfvirusantigensirulatiniuneplexes(i)nthedifferentdaysrphasesfillnessandlinitypesinpatientsfhfrs.theresultsshedthatthelevelfspeifiigaantibdyashigherinslight

3、asesthaniniddleandsevere;speifiigeantibdyanditsiashigherinsevereasesthaninslightandiddle.thsedifferenesereapparentinautephase(illnessphaseffeverandshk-ilguria,r3-8daysafterillness).butspeifiiigatypeshadndiferenes.keyrdsherrhagifeverithrenalsyndre(hfrs),speifiigaantibdy,speifiigeantibdy,irulatingiune

4、plexes(i),elisa對腎綜合征出血熱(hfrs)免疫發(fā)病機理研究較多的是igg、ig、ige型抗體14。已有陳訴在hfrs患者血清中可檢測到特異性iga抗體56。為進一步相識hfrs患者發(fā)病歷程中特異性抗體及其循環(huán)免疫復合物的形成及其致病性，我們平行測定了特異性iga、ige抗體以及抗原特異性iga、ige型循環(huán)免疫復合物(i)的程度，并從臨床分型、病期、病日等角度作了比擬闡發(fā)。1質(zhì)料與要領1.1hfrs病人血清網(wǎng)羅本市54例hfrs病人收支院時血清共108份。iga型檢測108份，ige型檢測此中93份。血清病期、病型漫衍見表1。表1待測血清病期、病型漫衍table1phasesa

5、ndtypesfillnessfrlletedsera病期phasefillness輕slight中iddle重severe合計ttal發(fā)熱fever(18)16(18)17(2)2(38)35休克少尿shkilguria(1)08(7)(5)5(14)12多尿plyuria(8)6(14)11(3)3(25)20規(guī)復revery(15)12(12)11(3)4(31)26合計ttal(42)34(52)46(14)13(108)93注：()外為ige型，()內(nèi)為iga型檢測血清數(shù)。nte:thenubersutftheparenthesisarethetypesfigeantibdytest

6、edandintheparenthesisarethenubersftestediga.1.2試劑1.3實行要領2效果2.1差異病期、臨床型hfrs病人血清中特異性抗體及特異性i程度(多少均勻滴度、gt)及陽性率效果。見表2。表2差異病期hfrs病人血清特異性iga、ige抗體及其特異性i的gt值與陽性率測定效果table2theresultsfspeifiiga,igeantibdiesandspeifiirulatingiueplexindifferentillnessphasesfhfrs抗體型別typefantibdy病期phasefillness病例數(shù)nubersfase輕型slig

7、ht(psitiverate)(%)中型iddle(psitiverate)(%)抗體speifiantibdyiantigenspeifi抗體speifiantibdyiantigenspeifi發(fā)熱fever38104.76(100.00)11.41(55.56)34.34(83.33)3.21(61.11)休克少尿14320.00(1/1)80.00(1/1)95.14(100.00)17.84(87.50)shkilguriaiga型多尿plyuria25246.75(100.00)21.87(62.50)185.62(100.00)30.25(85.71)規(guī)復revery31367.

8、58(100.00)28.99(80.00)213.58(100.00)11.48(58.33)綜算ttal108204.88(100.00)18.88(66.67)96.43(94.23)10.25(63.46)發(fā)熱fever3529.58(81.25)11.76(56.25)57.81(88.24)15.28(70.59)休克少尿12-114.95(100.00)12.63(71.43)shkilguriaige型多尿plyuria20220.80(100.00)7.10(50.00)249.99(100.00)15.26(63.64)規(guī)復revery26269.12(100.00)5.5

9、3(41.67)386.53(100.00)7.48(54.55)綜算ttal9380.06(91.18)8.24(50.00)148.64(95.65)12.51(67.39)抗體型別typefantibdy病期phasefillness病例數(shù)nubersfase重型severe(psitiverate)(%)合計ttal(psitiverate)(%)抗體speifiantibdyiantigenspeifi抗體speifiantibdyiantigenspeifi發(fā)熱fever3856.57(2/2)0.00(0/2)59.79(92.11)5.51(44.74)休克少尿1428.99(

10、80.00)43.94(80.00)67.87(92.86)27.40(85.71)shkilguriaiga型多尿plyuria25507.97(100.00)40.00(100.00)229.44(100.00)28.20(80.00)規(guī)復revery31320.00(100.00)26.75(75.00)292.62(100.00)20.05(70.93)綜算ttal108116.96(92.86)21.76(71.43)132.54(96.30)14.33(65.74)發(fā)熱fever35160.00(2/2)56.57(2/2)45.11(85.71)14.61(65/71)休克少尿1

11、2160.00(100.00)69.64(100.00)151.04(100.00)25.72(83.33)shkilguriaige型多尿plyuria20507.97(100.00)7.37(66.67)211.72(100.00)10.88(65.00)規(guī)復revery26640.00(100.00)9.28(66.67)346.64(100.00)6.67(50.00)綜算ttal93287.63(100.00)45.37(84.62)130.01(94.61)11.85(63.44)注：()外數(shù)字為gt值，()內(nèi)數(shù)字為檢出率。nte:thenubersutftheparenthesi

12、sarethevaluesfgt(geetrieantiter)andthenubersintheparenthesisarethepsitiverate.2.2差異病日檢出效果。見表3。表3差異病日hfrs患者血清特異性iga、ige抗體及其特異性i的gt值與檢出率測定效果table3theresultsfspeifiiga,igeantibdiesandspeifiirulatingiuneplexndifferentdaysfillnessinhfrspatients抗體型別typefantibdy病日daysfillness病例數(shù)nubersfase輕型slight(psitivera

13、te)(%)中型iddle(psitiverate)(%)抗體speifiantibdyiantigenspeifi抗體speifiantibdyiantigenspeifi010126.96(100.00)5.63(33.33)11.70(2/3)7.37(1/3)440104.39(100.00)18.36(61.54)50.98(95.24)4.60(47.62)iga821319.89(100.00)26.75(75.00)174.44(100.00)11.93(62.50)型1219289.75(100.00)22.87(71.43)170.36(100.00)23.20(81.82

14、)1611320.00(2/2)160.00(2/2)201.57(100.00)24.28(83.33)20287905.10(2/2)28.28(2/2)403.17(100.00)6.84(33.33)綜算ttal108204.08(100.00)18.88(66.67)96.47(94.23)10.05(63.46)01027.25(83.33)14.74(66.67)23.39(2/3)40.00(2/3)43636.06(81.82)15.26(63.64)84.14(94.74)15.15(73.68)ige815148.14(100.00)7.01(44.44)228.03(1

15、00.00)7.61(40.00)型1218226.40(100.00)2.08(16.67)319.92(100.00)18.82(72.73)168320.00(1/1)40.00(1/1)320.00(100.00)6.93(60.00)20286640.00(1/1)0.00(0/1)285.08(100.00)2.71(33.33)綜算ttal9380.06(91.18)8.24(50.00)148.64(95.65)12.51(67.39)抗體型別typefantibdy病期daysfillness病例數(shù)nubersfase重型severe(psitiverate)(%)合計tta

16、l(psitiverate)(%)抗體speifiantibdyiantigenspeifi抗體speifiantibdyiantigenspeifi01080.00(1/1)0.00(0/1)59.29(90.00)3.81(40.00)44030.60(83.33)23.39(66.67)59.61(92.50)9.20(57.50)iga8211280.00(1/1)160.00(1/1)271.24(10.00)21.42(71.43)型121940.00(1/1)40.00(1/1)191.97(100.00)23.75(78.95)1611403.20(3/3)18.57(2/3)

17、268.47(100.00)31.79(81.82)20287640.00(2/2)28.28(2/2)579.66(100.00)15.39(71.43)綜算ttal108116.96(92.86)21.76(71.43)132.85(96.30)14.33(65.74)01040.00(1/1)20.00(1/1)27.05(80.00)20.50(80.00)436201.58(100.00)80.00(100.00)75.13(91.67)20.04(75.00)ige815160.00(1/1)0.00(0/1)171.93(100.00)6.33(40.00)型1218640.00

18、(1/1)20.00(1/1)296.29(100.00)9.06(55.56)168639.68(2/2)4.47(1/2)380.54(100.00)7.73(62.50)20286905.10(2/2)28.28(2/2)479.45(100.00)5.02(50.00)綜算ttal93287.63(100.00)45.37(84.62)130.01(94.62)11.85(63.44)注：同表2。nte:astable2.3討論3.1特異性抗體測定據(jù)檢測效果可見，無論是輕、中或重型病例，hfrs-iga，ige抗體檢出程度(gt值)均隨病期(病日)希望而漸漸升高，這切合一樣平?？贵w產(chǎn)生

19、紀律。但從兩型特異性抗體檢出率角度闡發(fā)，那么上述差異不顯著。hfrs-iga抗體gt值在輕型病例高于中、重型病例(p0.05)，這一差異在發(fā)熱期到休克少尿期(或是8病日從前)表示得尤為突出，至規(guī)復期(或16病日后)那么表示不顯著。hfrs-ige抗體gt值在重型病例始終高于中、輕型，其差異在發(fā)熱期或病程第一周尤為顯著(p0.05)，支持該抗體在病程早期到場病理損傷的不雅點4，8。3.2抗原特異性i測定iga型特異性i的檢出率及gt值在病型間均無顯著差異(p0.05)。從病期希望或病日角度看，全部病例的檢出率及gt值均以休克少尿及多尿期為高，以發(fā)熱期為低；但在休克少尿、多尿及規(guī)復期間均無顯著統(tǒng)計學差異(p0.05)。ige型特異性i的檢出率及gt值那么在輕、中型與重型病例間存在顯著的差異(p0.05)，均以重型病例為高。假設從病期希望角度看，那么輕、中型病例在各病期間無顯著差異，但重型病例在發(fā)熱與休