PREDICTION AND DIAGNOSIS OF EARLY PSEUDOMONAS-AERUGINOSA INFECTION IN CYSTIC-FIBROSIS - A FOLLOW-UP-STUDY
PREDICTION AND DIAGNOSIS OF EARLY PSEUDOMONAS-AERUGINOSA INFECTION IN CYSTIC-FIBROSIS - A FOLLOW-UP-STUDY
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DOI：
10.1128/jcm.26.8.1565-1570.1988
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发表时间：
1988-08-01
影响因子：
9.4
通讯作者：
LITTLEWOOD, JM
中科院分区：
文献类型：
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作者：
BRETT, MM;GHONEIM, ATM;LITTLEWOOD, JM
采用酶联免疫吸附法对33例首次分离铜绿假单胞菌患者血清中铜绿假单胞菌表面抗原免疫球蛋白G （IgG）抗体进行测定。在首次分离铜绿假单胞菌前24个月，24例患者IgG抗体滴度高于对照组。另有5例患者在分离铜绿假单胞菌前滴度在控制范围内，但在分离后2个月内滴度上升至控制范围以上。在这29例患者中，铜绿假单胞菌的持续间歇分离伴随着滴度的进一步升高。高于控制范围的全身性免疫反应的存在表明组织入侵，因此感染。四名患者被认为没有感染：在整个研究期间，一到两次铜绿假单胞菌的分离均未伴有特异性抗体高于对照范围的增加。15例患者接受静脉抗假单胞菌化疗。5例患者发生了生物体的根除和滴度恢复到控制值，表明生物体完全被清除，而10例患者发生了继续分离，滴度仅部分下降。15例接受治疗的患者临床情况有所改善，而未接受治疗的患者临床情况在研究期间有所恶化。对两名患者进行持续类固醇治疗后，血清IgG浓度和滴度均显著下降，尽管仍持续间歇分离铜绿假单胞菌。这些结果证实并扩展了我们早期的发现，该试验似乎检测到，P。铜绿菌感染在非常早期的阶段，并有助于区分早期感染和无害定植。在没有持续类固醇治疗的患者中，在任何临床变化大到足以检测到之前，它似乎也是感染进展和静脉注射抗生素治疗反应的有用监测。类固醇治疗对早期铜绿假单胞菌感染患者的免疫反应和临床结局的影响有待进一步研究。
Immunoglobulin G (IgG) antibodies to Pseudomonas aeruginosa surface antigens in serum were estimated by enzyme-linked immunosorbent assay for all patients with whom P. aeruginosa was isolated for the first time during a study period of 3 years (33 patients). The titer of IgG antibodies was greater than control values at or up to 24 months before the first isolation of P. aeruginosa in 24 patients. Another five patients had titers that were within the control range before isolation of P. aeruginosa but increased to above the control range within the following 2 months. In these 29 patients, continuing intermittent isolations of P. aeruginosa were accompanied by further increases in titer. The presence of a systemic immune response above the control range indicates tissue invasion and hence infection. Four patients were deemed to have no infection: one or two isolations of P. aeruginosa were accompanied by no increase in specific antibodies to above the control range throughout the entire study period. Fifteen patients received intravenous antipseudomonal chemotherapy. Eradication of the organism and return of titer to control values, suggesting complete removal of the organisms, occurred in 5 patients, while continued isolations and only a partial decrease in titer occurred in 10 patients. The 15 patients who received treatment improved clinically, in contrast to untreated patients, whose clinical state worsened during the study period. Continuous steroid treatment, given to two patietns, was accompanied by a dramatic decrease in both serum IgG concentration and titer, despite continuing intermittent isolations of P. aeruginosa. These resuts confirm and extend our earlier finding that this assay appears to detect,P. aeruginosa infection at a very early stage and helps in differentiating between early infection and harmless colonization. It also appears to be a useful monitor of the progress of infection and the response to intravenous antibiotic treatment in these early stages of infection, before any clinical changes are sufficiently large to be detected, in patients who were not on continuous steroid therapy. The effect of steroid treatment on the immunological response and clinical outcome of patients with early P. aeruginosa infection requires further investigation.