新生溶血病患儿红细胞上致敏抗体对Rh 血型检测的影响

目的:探讨新生溶血病患儿红细胞致敏抗体对其Rh血型鉴定的影响。方法:采用抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)五种方法对近三年来我院收集的163例新生溶血病患儿红细胞进行Rh血型检测,对五种检测结果不一致的患儿红细胞进行0.2 M 2-巯基乙醇抗体放散,比较放散后五种方法检测结果并验证其准确性。结果:29例直接抗体试验阳性患儿的五种Rh血型检测结果不一致,经0.2 M 2-巯基乙醇抗体放散后检测结果均一致。Rh血型准确性验证表明,红细胞放散测定的Rh血型完全符合临床现象。结论:患儿红细胞的致敏抗体达一定数量后,会影响抗球蛋白法、盐水法、微柱凝胶法(Rh血型测定型)、凝聚胺法和抗血清微柱凝胶法(Ig G型)对Rh血型鉴定,0.2M 2-巯基乙醇抗体放散法是一种正确鉴定新生儿Rh血型的简单可行的方法。     

2623名患者红细胞不规则抗体筛选结果分析*

目的:对红细胞抗体筛选阳性的标本进行红细胞不规则抗体特异性鉴定与分析,为临床安全输血提供帮助。方法:2011年8月至2018年12月天津市各医院送至本中心实验室检测的2623份血液标本,进行红细胞不规则抗体筛选和鉴定;采用低离子强度溶液-抗人球蛋白微柱凝胶卡方法和盐水直接离心方法进行抗体筛选和抗体鉴定。结果:共检出2744个红细胞抗体,其中2139个为同种抗体,509个为自身抗体,96份标本未能确定抗体特异性;在所检出的同种抗体中,Rh系统的抗体最常见,占比为54.7％(其中抗-E 26.2％,抗-c 8.7％,抗-C 7.7％,抗-e 6.9％,抗-D 4.9％),MNS系统、Lewis系统、Kidd系统、P系统、Duffy系统、Kell系统、Diego系统均有抗体检出。结论:在输血前检测中,为预防检出不规则抗体的情况出现,应提前备血,以免由此导致的延迟输血,影响治疗。     

39302例患者不规则抗体筛查结果分析及其临床意义

目的:对需要输血的患者进行输血前不规则抗体筛查,为受血者选择合适的供血者血液成份,确保临床输血安全有效地进行。方法:选择2009年10月1日～2011年10月31日在本院入院进行治疗性输血和手术备血的患者,采用微柱凝胶法对受血者进行血清中不规则抗体的筛查,并对筛查阳性标本进抗体特异性鉴定。确保临床输血安全有效。结果:在39302例受血者血清中共检测出不规则抗体69例(阳性率0.18%),其中抗-D 5例、抗-E 15例、抗-C 2例、抗-c 2例、抗-e 2例、抗-C,e 1例、抗-M 8例、抗-S 1例、抗-Lea2例、抗-Leb1例、自身抗体5例、25例未确定抗体的特异性。结论:不规则抗体筛查对保证输血安全、降低免疫性溶血性输血反应、及时寻找相容血液及预防和减少新生儿溶血病的发生很有必要。     

卡式微柱凝胶法在猴血型鉴定中的应用

灵长类动物的ABO血型抗原都表达在组织器官内,而不是在红细胞上,这给灵长类动物血型的鉴定带来很大的困难。为找到更加简捷、准确鉴定灵长类动物类人ABO血型的方法,采用近年来临床上广泛应用的卡式微柱凝胶正、反定型法对34只猕猴和16只食蟹猴的血型进行了鉴定,并与肾组织免疫组化法的检测结果进行比较。结果显示:卡式微柱凝胶正定型法的检测结果中无一例为阳性结果;血浆中的纤维蛋白原和人-猴种属间非特异性抗体都会对卡式微柱凝胶反定型法的部分检测结果产生干扰;采用经正常人O型红细胞吸附处理后的清亮血清,卡式微柱凝胶反定型法的检测结果明确,与免疫组化法判定结果一致。由此得出:卡式微柱凝胶反定型法可以用于灵长类动物血型的鉴定,其主要干扰因素为血浆内的纤维蛋白原和人-猴种属间非特异性抗体,在采用清亮血清及经正常人O型红细胞吸附处理后能消除其干扰。     

不规则抗体筛查对临床安全输血的意义

目的:不规则抗体是血浆中除了抗A、抗B以外的其他血型抗体,会引起血型鉴定困难、疑难配血、溶血性输血反应及新生儿溶血症。本文探讨不规则抗体在住院患者中的发生情况,为需要输血的患者选择匹配的血液供应,确保临床输血安全、合理、有效。方法:利用Ⅰ~Ⅲ类谱细胞用微柱凝胶抗人球蛋白检测卡对住院患者血标本进行不规则抗体筛查,再对阳性标本利用Ⅰ~Ⅻ类谱细胞进行特异性鉴定。结果:13889例受检血标本中,检出不规则抗体25例,阳性率为0.18%。检出的不规则抗体涉及Rh、MNSs、Lewis、Kidd四个血型系统,所占比例分别为80%、8%、8%、4%。且不规则抗体在女性患者中的检出率高于男性患者。结论:输血前对患者进行不规则抗体筛查及特异性鉴定,可有效减少和避免溶血性输血反应的发生,对于安全输血是十分必要的。     

应用改良流式法检测猕猴和食蟹猴体内血型抗体水平的分布情况

绝大部分灵长类动物存在与人类相似的ABO血型系统,该研究采用改良流式法(flow cytometry method,FCM)检测猕猴及食蟹猴血清中血型抗体水平的分布情况。以流式细胞术为基础,使用商品化人源红细胞为靶细胞,并通过加入特异性荧光标记的抗人IgM或IgG二抗,对收集的实验用猕猴及食蟹猴的血清样本进行检测,以人类健康受试者的血清样本为对照,比较两者血型抗体水平的差异。结果显示:预先用人O型浓缩红细胞吸附猴血清中所含种属间非特异性抗体后,FCM法能够准确检测其血型抗体水平及分型,并且发现猴血清中天然血型抗体的水平明显低于健康人(P<0.05)。由此得出:通过预处理清除非特异性抗体的干扰后,FCM法同样适用于灵长类动物血清中血型抗体的检测,也为构建灵长类动物模拟人ABO血型不合器官移植模型提供了技术保障和实验数据。     

抗人IgG和抗人IgM单克隆抗体的特性鉴定及应用

目的:制备特异性高的抗人Ig G和抗人Ig M单克隆抗体,并应用于临床血清学检测试剂盒,为其提供优质的二抗。方法:以人Ig G和Ig M为抗原,免疫BALB/c小鼠,通过传统杂交瘤融合和筛选技术制备抗人Ig G和抗人Ig M单克隆抗体;经体内诱生法制备腹水并纯化;采用酶联免疫吸附试验(ELISA)和Western印迹进行交叉筛选和特异性鉴定,并对筛选出的单抗进行辣根过氧化物酶(HRP)标记,再与市售的检测病原微生物抗体试剂盒中对应的HRP标记的二抗(抗人Ig G和抗人Ig M)做对比分析。结果:筛选到2株可稳定分泌抗人Ig G单抗和2株抗人Ig M单抗,经交叉反应、Western印迹及对比实验分析,证明这4株单抗效价高、特异性好,比临床试剂盒中的酶标二抗特异性强、敏感度高。结论:获得4株特异性强、敏感度高的抗人Ig G和抗人Ig M单克隆抗体,可为各种病原微生物血清学的检测提供二抗试剂,具有良好的应用价值。     

ABO血型正反定型及交叉配血实验在外科病人手术输血中应用

目的:探讨ABO血型正反定型及交叉配血实验在外科手术患者输血中的应用效果及影响因素。方法:选取我院自2017年2月-2019年2月收治的80例行ABO正反定型与交叉配血治疗的外科手术患者,记录ABO反定型与交叉配血不合的标本,使用2-Me处理被患者自身冷抗体凝集的红细胞,同时使用微柱凝胶法、凝聚胺法对血型不规则抗体以及特异性进行筛选和鉴定。分析ABO血型反定型不符合以及交叉配血不合的影响因素。结果:对正反定型完全无凝集反应的80例血清标本进行交叉配血实验,其中8例存在凝集反应,配血不合情况;导致外科手术患者输血中ABO血型反定型不符交叉配血不合的主要因素包括自身冷抗体、血型抗原性减弱、血型不规则抗体以及血型抗体效价减弱等。结论:ABO血型正反定型及交叉配血治疗中的患者中,大部分配血一致,少数的交叉配血不合,主要与自身冷抗体、血型抗原性减弱、血型不规则抗体以及血型抗体效价减弱等因素相关。     

模拟表位结合夹心化学发光法检测抗A和抗B效价

目的:获得A/B血型抗原的模拟多肽,并将其与夹心化学发光免疫分析(chemiluminescence immunoassay, CLIA)相结合,以开发更有效的方法来测量A/B抗体的效价。方法:分别用NaM87-1F6和HEB-29对噬菌体12肽库进行三轮淘选。对经酶联免疫吸附实验(ELISA)确定的阳性菌斑进行测序分析,根据其氨基酸组成合成模拟多肽,并通过竞争性ELISA、凝集抑制等方法检测其抗原性。随后将获得的模拟多肽与CLIA结合,检测A、B抗体效价,制作标准曲线以及与现有的微柱凝胶法(CAT)进行相关性对比。结果:经过三轮淘选和相关鉴定后得到13个与抗A抗体和19个与抗B抗体特异性相互作用的噬菌体克隆,其中分别有9个(MTRIQLRMMRLH)和12个(PQMSRHRMRMLP)展示相同的氨基酸序列,据此合成的多肽分别命名为MTR和PQM。竞争性ELISA结果表明,MTR能够特异性拮抗A抗体和A抗原的替代多肽的免疫结合;PQM能够特异性拮抗B抗体和B抗原的替代多肽的免疫结合。凝集抑制实验表明MTR/PQM可以特异性抑制A/B型红细胞与抗A/B之间的相互作用。结合模拟肽的夹心CLIA具有较宽的线性范围(2-2048)和良好的线性相关系数(对于A抗体R~2=0.9566,对于B抗体R~2=0.9762)。基于CLIA方法和CAT测得的抗体滴度结果高度相关(P0.001)。结论:MTR和PQM有良好的A或B抗原性,具有成为其人工替代品的潜能。模拟多肽与夹心CLIA相结合能够实现对A、B抗体滴度的定量检测,且其结果准确可靠。     

微柱凝胶技术诊断伤寒及副伤寒的临床应用

目的 比较微柱凝胶技术(MGT)与肥达反应法(WR)在诊断伤寒及副伤寒中的意义.方法 采用微柱凝胶技术及肥达反应法分别检测317例疑似伤寒及副伤寒患者.结果 317例疑似患者中,通过对已被临床确诊或得到血培养和(或)粪便培养阳性报告的患者血清标本检测,微柱凝胶法要比肥达反应法平均提高1～2个滴度.统计学差异有显著性.结论 微柱凝胶技术检测伤寒杆菌抗体方法简便快速,灵敏度高,便于观察,能为临床早期诊断,快速诊断提供重要的参考依据.     

流行性出血热冻干致敏人O型血球的研制及其应用

本文应用致敏的人O型血球研究反向间接血凝(RPHA)和反向间接血凝抑制(RPHI)方法用以检测流行性出血热抗原抗体,并试验成功用pH9.0硼酸盐水制备灭活鼠脑病毒液作为抗原。为抗原制备提供了一种简便的方法。以上RPHA法用于检测组织培养内病毒与用荧光法检测细胞内病毒抗原法结果一致,用RPHI检测病人血清抗体效价,特异性高,敏感性与IFA相同。该致敏血球和抗原是冻干制品,稳定性好、使用方便,是一种代替荧光检测病毒抗原和抗体的良好制品。     

新型冠状病毒胶体金抗原快速检测试剂的研制及性能评价*

目的:建立新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)胶体金抗原快速检测试剂的制备方法,并对检测试剂的性能指标进行评价。方法:采用柠檬酸三钠还原法制备胶体金溶液,用鼠抗核衣壳蛋白(nucleocapsid protein, NP)单克隆抗体及二硝基苯酚-牛血清白蛋白(DNP-BSA)作为标记抗体,硝酸纤维素膜上分别包被鼠抗核衣壳蛋白单克隆抗体和兔抗DNP多抗作为检测线和质控线制备免疫胶体金试纸条;对试剂最低检出限、交叉反应性、加速稳定性及临床诊断特异性和灵敏度进行性能评价。结果:检测热灭活培养物的最低检出限为2.0×10² TCID₅₀/mL;测试16种常见呼吸道病原体高浓度样本均无交叉反应;试剂盒50℃加速破坏8周稳定。临床及健康人群鼻咽拭子样本测试,诊断灵敏度为96.67%(29/30),特异性为99.23%(129/130),总符合率为98.75%(158/160);一致性检验Kappa值为0.959 0,P<0.05。结论:SARS-CoV-2胶体金抗原快速检测试剂检测灵敏度和特异性高,检测速度快,操作便携,无需设备,肉眼观察,可作为现有核酸检测法的补充手段,用于新型冠状病毒的早期筛查。     

HPV Testing by cobas HPV Test in a Population from Catalonia

Background

HPV testing in cervical cancer screening has been proposed as an alternative or complementary to cytology in women older than 30 years. However, adequate clinical sensitivity and specificity are crucial for a new test to be implemented. Hybrid Capture 2 (HC2) has proved good clinical performance in selecting women at risk for high-grade intraepithelial lesions with a high sensitivity and specificity. cobas HPV Test has been recently launched and its performance in different clinical settings needs to be determined.

Objectives

The aim of this study was to evaluate the cobas HPV Test for the detection of cervical HPV infection in a population of women in Catalonia (Spain) using HC2 as a reference.

Materials and Methods

Cervical liquid cytology samples from 958 women have been studied. Sensitivity was analyzed in 60 samples from patients with a high-grade intraepithelial lesion (≥CIN2) on histology and specificity was determined in 898 samples from women with no ≥CIN2. All cases had HC2 and cobas HPV Test performed. Statistical analyses of sensitivity, specificity and comparison between HC2 and cobas HPV Test by a non-inferiority test were applied.

Results

Sensitivity of HC2 and cobas HPV Test for detecting ≥CIN2 proved identical (98.3%) while specificity was 85.3% and 86.2% respectively. The non-inferiority test demonstrated that cobas HPV Test surpassed 90% sensitivity and 98% specificity of HC2.

Conclusion

The cobas HPV Test results fulfilled sensitivity and specificity requirements for HPV based cervical cancer screening and for the triage of minor cytological abnormalities, allowing its introduction in clinical settings.     

Comparative evaluation of whole blood D-dimer test to plasma D-dimer test for diagnosis of disseminated intravascular coagulation

Three rapid D-dimer test methods were compared for the diagnosis of acute disseminated intravascular coagulation (DIC). These were (a) SimpliRED, an autologous red cell agglutination assay. (b) DIMERTEST latex agglutination assay, containing monoclonal antibody DD-3B6/22(6), and (c) D-DI latex agglutination assay containing mouse anti-human D-dimer monoclonal antibodies. The D-DI latex method having higher sensitivity (100%) and specificity (81%) in clinically acute DIC was postulated as the gold standard and compared with the other two methods. The results suggest that D-DI latex agglutination assay containing mouse anti-human D-Dimer monoclonal antibodies are the better assay methods amongst all the three kits analyzed. It is advisable to look for the nature of the antibody used to coat the latex particles in plasma based kits. In emergency setting RBC kits may be of some use as rapid diagnosis is advantageous.     

Evaluation of the fluorescence polarization assay and comparison to other serological assays for detection of brucellosis in cervids

The complement fixation test (CFT), competitive enzyme immunoassay (CELISA), indirect enzyme immunoassay (IELISA) and fluorescence polarization assay (FPA) were evaluated for the detection of antibodies to Brucella abortus and Brucella suis biotype 4 in caribou (Rangifer tarandus caribou), elk (Cervus elapus), red deer (Cervus elapus), and reindeer (Rangifer tarandus tarandus). When combining the data the FPA and the CELISA were determined to be the most suitable tests for serodiagnosis of Cervidae. The overall actual sensitivity of the CFT and the IELISA was 100%. The overall actual sensitivity for the CELISA and FPA was 99%. The overall relative specificity of the CFT (including treatment of anti-complementary data as positive or negative for analysis), the CELISA, the IELISA and the FPA were 65%, 93%, 99%, 99%, and 99%, respectively. The specificities of the buffered plate agglutination test (BPAT), the CFT, the CELISA, the FPA and the IELISA for 55 elk vaccinated with B. abortus strain 19 and tested 4 mo post vaccination were 14%, 31%, 51%, 84%, and 2%, respectively. The FPA is the diagnostic test of choice because it has sensitivity and specificity values comparable to the CELISA; it has the capability to distinguish vaccinal antibody and antibody resulting from exposure to cross-reacting organisms such as Yersinia enterocolitica 0:9 from antibody to Brucella spp. in most cases; it is technically simple to do; it is adaptable to field use and it is relatively inexpensive.     

The Pertussis Serological Potency Test. Collaborative study to evaluatereplacement of the Mouse Protection Test.

The Pertussis Serological Potency Test (PSPT)--based on in vitro assessment of the humoral immune response against Bordetella pertussis--was developed as an alternative for the Mouse Protection Test (MPT). A small-scale collaborative study was carried out in five laboratories to evaluate the relevance and reliability of the PSPT. The study has been divided into three separate phases, each with its own objective. A pilot-phase study of the antibody detection assay, the 18323-whole cell ELISA (WCE), was included for training purposes. Significant differences in absorbance and antibody concentrations between the laboratories were found. In the Phase I study, the intra-assay, inter-assay and inter-laboratory precisions of the 18323-WCE were assessed. Although a precision of less than 20% was not always established and significant differences in antibody concentrations were found at random throughout the Phase I study, the ranking of the antibody concentrations corresponded well between the laboratories and should warrant a reliable potency estimation of whole cell vaccines (WCV's) in the PSPT. Phase II was a comparative study of the PSPT and the MPT to evaluate the implementation of the PSPT, to demonstrate correlation and to compare the reproducibility and reliability of both tests. The mean antibody concentrations per vaccine dose in the PSPT and the survival of mice in the MPT differed significantly within and between the laboratories. Nevertheless, the potencies of the vaccines under test estimated in both test models did not differ significantly (P>0.05). The PSPT and MPT correlated well in chi2-test of homogeneity within and between the laboratories. The potencies were similar (overall ratio=0.877), but the PSPT is more reproducible and reduces the chance of re-testing due to the smaller 95% confidence intervals. We have demonstrated that the PSPT is a valid model to estimate the potencies of pertussis WCV's from different manufacturers. Moreover, the 18323-WCE is easy to carry out and the intra-assay precision and antibody ranking warrants a reliable potency testing of pertussis WCV's in the PSPT.     

Automatic pre-transfusion serology]

This paper describes an automated apparatus combining Rosenfield's and Lalezari's antibody screening and identification basic technics. PVP bromelin and low ionic strength acid polybren channels are used; agglutinates are decanded; the remaining cells are hemolyzed and the optical density is then measured through a colorimeter and recorded on a chart; speed is of 40 samples an hour. This machine was also used for irregular antibody screening and identification. Sensitivity is shown to be equal to that of manual technics for ABO, Lewis, Lutheran as well as K, S, M, Kpb, Xga, U and Vel antibodies detection. Nevertheless, a much greater sensitivity is achieved (titers 3 to 10 times higher) than by manual technics for Rh, -k, S, Fya antibodies detection. Polybren channel is suitable for anti-Rh, Duffy, I and M (human detection; bromelin channel however, has a greater sensitivity for other specificities. Anti-M and anti-N sera from rabbits were shown to be non specific when using this machine. Over almost 15 000 sera tested, no antibody (detected by manual techniques) escaped the automated screening. This antibody detection machine was applied to compatibility tests prior to transfusion. (21 480 units were tested. aimed to be transfused to 5 611 patients). A third, PVP without bromelin, was set in parallel in order not to let escape any anti-M, even a weak one. The sera distributor was slaved to the cells distributor so that the whole procedure was automated. Furthermore, each serum was tested against red cells to be transfused, but also against the patient's own red cells to be transfused, but also against the patient's own red cells and against two selected red cells panels, so as to ensure irregular antibody detection at the same time. Using this machine, 3 to 4% of the cell samples were rejected, i.e. more than with usual techniques. All manually detected antibodies were identified, but also some others, which showed only weak reactions by classical techniques. Total results can be obtained within 20 to 30 minutes, which is quite rapid, compared to techniques using for example antiglobulin tests.     

A comparison of a solid phase IRC assay and the PSIFT for detection of antibodies to platelets.

A rapid solid phase indicator red cells assay (IRCA) for detection of platelet antibodies was developed and its sensitivity compared with PSIFT. Platelets were attached to the surface of polystyrene microtitre plate wells by means of a sodium carbonate buffer and centrifugation. Uncovered areas were blocked by a gelatin blocking buffer. After serum incubation bound platelet-specific antibodies were made visible by anti-IgG-coated indicator red cells and a brief centrifugation. A positive result, meaning the presence of an anti-platelet antibody was indicated by red cell adherence over the reaction surface. In the absence of serum antibodies to platelets the indicator red cells formed a pellet. The IRCA showed a high sensitivity; the anti-platelet antibody Thrombocyte was detectable until a dilution of 1:1,600 whereas the same antibody in the PSIFT could only be detected until a dilution of 1:400.     

Frequency analysis of the antibody specificity repertoire of mitogen-reactive B cells and "spontaneously" occurring "background" plaque-forming cells in nude mice

The antibody specificity repertoire of lipopolysaccharide (LPS)-reactive B cells has been determined in the spleens and bone marrow (BM) of C57BL/Ka athymic nude mice using a limiting dilution culture system that allows the growth and development of every LPS-reactive B cell into a clone of IgM-secreting cells. In addition, the numbers of "spontaneously" occurring ("background") IgM-, IgG-, and IgA-secreting cells as well as the "background" IgM antibody specificity repertoire has been assessed in spleens and BM. The frequencies of antigen-specific LPS-reactive B cells of C57BL/Ka nude and thymus-bearing mice showed a great similarity and ranged from 1 in 1000 to 1 in 2500 for sheep red blood cells (SRBC), horse red blood cells (HRBC), and goat red blood cells (GRBC), from 1 in 10 to 1 in 25 for 5-iodo-3-nitrophenyl-coupled (SRBC), from 1 in 15 to 1 in 150 for 4-hydroxy-3,5-dinitrophenyl-coupled SRBC, and from 1 in 70 to 1 in 140 for 2,4,6-trinitrophenyl-coupled SRBC. The specificity repertoire of the "background" IgM-secreting cells differed from that of age-matched thymus-bearing controls and was different in young and old C57BL/Ka nude mice. Within the limitations of having assessed only a minor fraction of the total B-cell antibody specificity repertoire and supposing that nude mice are largely devoid of functional T cells, the data presented suggest that the generation of the specificity repertoire of newly-formed B cells is hardly or not affected by T cells. On the other hand, T cells do affect the expression of the established repertoire, represented by "background" immunoglobulin-secreting cells.     

一种基于量子点检测抗CCP抗体的免疫荧光层析法

抗环瓜氨酸多肽 (cyclic citrullinated peptide, CCP) 抗体是类风湿关节炎 (rheumatoid arthritis, RA) 早期诊断的重要生物标志物. 为了实现对RA的早期诊断,本研究建立了一种基于CdTe量子点标记技术检测抗CCP抗体的免疫荧光层析法. 将CCP多肽与小牛血清白蛋白 (bovine serum albumin, BSA) 连接,再将CCP-BSA和 羊抗鼠IgG分别在硝酸纤维素膜 (nitrocellulose membrane, NC膜) 上划线,作为检测线 (test line, T线) 和质控线 (control line, C线). 制备量子点并在量子点上标记鼠抗人IgG,喷在玻璃纤维上并烘干,最后组装大卡、切割并封装制成检测试纸条. 应用该试纸条检测了RA患者及健康人血清临床样本200份,以酶联免疫吸附 测定法 (enzyme-linked immunosorbent assay, ELISA) 为对照,计算免疫荧光层析法的检测灵敏度和特异性. 结果显示,建立的量子点免疫荧光层析试纸条检测抗 CCP抗体的灵敏度为97.5 %,特异性为95.8%. 该方法操作简单、快速,可实现床旁检测 (point-of-care testing, POCT),能应用于RA的早期诊断.