IMMUNE-RESPONSES DURING HUMAN SCHISTOSOMIASIS .12. DIFFERENTIAL RESPONSIVENESS IN PATIENTS WITH HEPATOSPLENIC DISEASE
IMMUNE-RESPONSES DURING HUMAN SCHISTOSOMIASIS .12. DIFFERENTIAL RESPONSIVENESS IN PATIENTS WITH HEPATOSPLENIC DISEASE
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DOI：
10.4269/ajtmh.1986.35.793
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发表时间：
1986-07-01
影响因子：
3.3
通讯作者：
GAZZINELLI, G
中科院分区：
文献类型：
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作者：
COLLEY, DG;GARCIA, AA;GAZZINELLI, G
对 34 名住院患者和 12 名门诊患者（全部患有肝脾曼氏血吸虫病）的外周血单核 (PBMN) 细胞对血吸虫抗原制剂的反应进行了评估，并与 40 名肝肠型曼氏血吸虫病患者和 39 名更常见的慢性肠型曼氏血吸虫病患者进行了比较。在暴露于血吸虫卵抗原（SEA）、成虫抗原（SWAP）和尾蚴抗原制剂（CERC）后测量PBMN细胞的胚芽发生反应。所有小组都有一些人对部分或全部这些准备工作没有反应。在住院肝脾组中，> 50% 对 SEA 没有反应。对每组反应的分析表明，所有反应者都可以细分为中度反应者和高反应者。 SEA 高反应者的实验减去对照值为 %G 每分钟 8,000 次计数 (CPM)。对于 SWAP 和 CERC，该任意截止值分别为 > 25,000 CPM 和 > 11,000 CPM。各组中 SEA 高反应者的百分比差异很大。慢性肠道组为 23%，慢性肝肠组为 40%，门诊肝脾患者为 67%，住院肝脾患者为 20%。先前的研究表明，94% 的早期（2-3 个月）急性曼氏血吸虫病患者对 SEA 具有高反应性，没有一例是无反应者。此外，在该范围的另一端，100% 的前曼氏血吸虫病患者（7-35 年前接受治疗并治愈）是 SEA 的高反应者。没有人对任何抗原制剂无反应。据建议，在急性感染期间，所有患者都对 SEA 表现出强烈的反应。在持续感染后，大多数患者（75%）都会调节这种华丽的反应。然而，持续高反应者占慢性肝肠病例的 40% 和近 70% 的门诊肝脾患者。后两组可能代表住院肝脾患者群体中发现的严重临床疾病的早期形式。 50% 的住院患者表现出过敏反应，对 SEA 不再有反应，而只有 20% 的患者是高反应者。化疗后很久，以前的慢性患者的抗 SEA 调节机制似乎已经消退，留下了强烈的抗 SEA 反应性。
Thirty-four hospitalized patients and 12 ambulatory patients, all with hepatosplenic schistosomiasis mansoni were evaluated in regard to their peripheral blood mononuclear (PBMN) cell responses to schistosomal antigenic preparations and compared with groups of 40 patients with the hepatointestinal form and 39 patients with the more common, chronic intestinal form of schistosomiasis mansoni. PBMN cell blastogenic responses were measured upon exposure to schistosomal egg antigens (SEA), adult worm antigens (SWAP) and a cercarial antigenic preparation (CERC). All groups had some individuals who did not respond to some or all of these preparations. In the hospitalized hepatosplenic group > 50% did not respond to SEA. Analysis of the responses in each group revealed that all responders could be subdivided into moderate and high responders. High responders to SEA had experimental minus control values of %G 8,000 counts per minute (CPM). For SWAP and CERC, this arbitrary cut-off value was > 25,000 CPM and > 11,000 CPM, respectively. The percent of high SEA responders in the groups differed considerably. This was 23% in the chronic intestinal group, 40% in the chronic hepatointestinal group, 67% for ambulatory hepatosplenic patients and 20% for hospitalized hepatosplenic patients. Previous studies had demonstrated that 94% of patients with early (2-3 month) acute schistosomiasis mansoni were high responders to SEA and none were nonresponders. Furthermore, at the other end of the spectrum, 100% of former schistosomiasis mansoni patients (treated and cured 7-35 years previously) were high responders to SEA. None were nonresponders to any of the antigen preparations. It is proposed that during acute infection all patients express vigorous responses to SEA. Upon continued infection most patients (75%) modulate this florid response. However, continued high responders comprise 40% of the chronic hepatointestinal cases and almost 70% of the ambulatory hepatosplenic patients. These latter 2 groups may likely represent early forms of the severe clinical disease found in the hospitalized hepatosplenic patient population. Fifty percent of the hospitalized group appear anergic and no longer respond to SEA, while only 20% are high responders. Long after chemotherapy it appears that the anti-SEA regulatory mechanisms of former chronic patients have subsided, leaving strong anti-SEA responsiveness.