孟鲁司特钠联合双歧杆菌四联活菌片 对小儿过敏性紫癜的疗效

摘要：目的 对孟鲁司特钠联合双歧杆菌四联活菌片治疗小儿过敏性紫癜的临床疗效进行分析。方法 选取2015年3月1日至2018年3月31日我院收治的96例过敏性紫癜患儿为研究对象,依据随机数字表法分为A组、B组、C组、D组,每组24例。A组患儿施以常规临床治疗,B组在A组基础上给予孟鲁司特钠治疗、C组在A组基础上给予双歧杆菌四联活菌片治疗、D组在A组基础上施以孟鲁司特钠联合双歧杆菌四联活菌片治疗,4组患儿持续用药至出院后2个月。结果 A组患儿治疗有效率为66.67%,皮肤紫癜消失时间为（10.49±3.01）d,关节肿痛消失时间为（5.87±1.56）d,腹痛消失时间为（4.05±1.28）d,Alb水平为（27.11±7.80）mg/L,β2-MG水平为（0.31±0.15）mg/L,治疗后复发率为29.17%。D组患儿治疗有效率为91.67%、皮肤紫癜消失时间为（6.98±2.57）d,关节肿痛消失时间为（3.07±1.04）d,腹痛消失时间为（2.77±1.05）d,Alb水平为（22.00±8.47）mg/L,β2-MG水平为（0.19±0.06）mg/L,治疗后复发率为4.17%。D组患儿各指标与A组比较差异均有统计学意义（均P＜0.05）。B、C组患儿治疗有效率高于A组,但低于D组。B、C组患儿皮肤紫癜消失时间、关节肿痛消失时间、腹痛消失时间与A组比较差异无统计学意义（P＞0.05）,与D组相比差异有统计学意义（P＜0.05）。结论 孟鲁司特钠联合双歧杆菌四联活菌片对小儿过敏性紫癜的疗效显著,能减少患儿不良反应发生,促进患儿恢复健康,值得临床推广。     

Immune response to CagA protein is associated with improved platelet count after Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura

BACKGROUND: Improvement in platelet counts has been reported after eradication of Helicobacter pylori in patients with idiopathic thrombocytopenic purpura (ITP). We examined the levels of serum markers of gastritis and anti-CagA (cytotoxin-associated gene A) IgG antibody in patients with ITP to investigate whether these factors are associated with the platelet response after H. pylori eradication therapy. MATERIALS AND METHODS: One hundred and sixteen consecutive patients with ITP were assessed for H. pylori infection by (13)C-urea breath test and serum H. pylori antibody test. Patients with H. pylori infection received eradication therapy. Before and after eradication therapy, we evaluated serum levels of gastrin, pepsinogen (PG)-I, and PG-II and the anti-CagA IgG antibody titer. RESULTS: H. pylori infection was found in 67 (58%) of the 116 patients with ITP. Fifty-two infected patients received eradication therapy, which was successful in 44 patients (85%). Twenty-seven patients (62%) showed an increased platelet count and were identified as responders. The duration of ITP was shorter in responders than in nonresponders (p = .017). There was no difference of the levels of gastrin and PGs between responders and nonresponders. Before eradication therapy, the serum anti-CagA antibody titer did not differ significantly between responders and nonresponders. However, reduction in the anti-CagA antibody titer after eradication therapy was significantly greater in responders than in nonresponders (p = .013). CONCLUSIONS: H. pylori eradication therapy improves the platelet count in H. pylori-positive patients with ITP of short duration. Immune response of hosts to CagA protein of H. pylori may play a role in the pathogenesis of ITP.     

抗幽门螺杆菌治疗在儿童特发性血小板减少性紫癜中的作用

目的 探讨联合抗幽门螺杆菌（H.pylori）在特发性血小板减少性紫癜（ITP）患儿治疗中的作用.方法 将58例血清H.pylori抗体阳性的ITP患儿随机分为：A组：给予根治性抗H.pylori,大剂量丙种球蛋白和强的松治疗;B组：未予抗H.pylori,其他治疗相同.另设正常对照组（C组）：选血清H.pylori抗体阴性的健康入学儿童.观察A、B两组治疗前和3月后T细胞亚群分布,血小板相关免疫球蛋白G（PAIgG）水平变化,及两组临床疗效和复发率.结果 各组间总T细胞无变化,A、B两组治疗前T细胞亚群分布异常,CD4^＋细胞减少,CD8^＋细胞增加,CD4^＋/CD8^＋比值下降,PAIgG水平升高,两组间差异无显著性（P均＞0.05）.治疗后3月复查,A组CD4^＋细胞增加,CD8^＋细胞减少,CD4^＋/CD8^＋比值和PAIgG值恢复至正常对照组水平,而B组虽有所恢复,但未达正常,A组显效＋良效97%,复发率为3%,B组显效＋良效70%,复发率为30%,两组差异有显著性（P均＜0.05）.结论 对有H.pylori感染的ITP患儿,联合抗H.pylori治疗比单纯应用免疫抑制治疗,异常的T细胞亚群和PAIgG水平恢复较快,疗效较好,复发率低.     

儿童过敏性紫癜的临床特点及其肾损害的相关因素分析

摘要目的：总结儿童过敏性紫癜的临床特点,并分析其肾损害的相关因素。方法：选择2006年2月~2012年8月我院小儿科诊治的过敏性紫癜患儿86例,根据是否伴有肾脏损害分为观察组（34例）和对照组（52例）,分析两组患者的一般临床资料,总结儿童过敏性紫癜的临床特点,并探讨导致儿童过敏性紫癜并发肾损害的相关因素。结果：（1）儿童过敏性紫癜的诱因包括感染、过敏、疫苗接种、寄生虫病史及其它原因,其中感染比例最高,占66．28％;首发症状包括紫癜、腹痛及关节痛的一种或多种,其中紫癜比例最高,占59．30％。（2）观察组患儿中年龄≥8Y、皮疹反复≥4w及血FIB升高的比例分别为73．53％（25／34）、52．94％（18／34）和26．47％（9／34）,均显著高于对照组患儿（P〈0．05）,非条件Logistic多元回归分析结果示皮疹反复≥4W及血FⅢ升高为过敏性紫癜患儿发生肾脏损伤的危险因素。结论：儿童过敏性紫癜的主要诱因为感染,典型临床表现为紫癜,皮疹反复芝4w及血FIB升高为过敏性紫癜患儿发生肾脏损伤的危险因素。     

Manufacture of recombinant polyclonal antibodies

Polyclonal antibody therapy in the form of hyper-immune serum has for more than a century been used for treatment of many infectious diseases. However, with the emergence of first antibiotics and later recombinant monoclonal antibody therapy, the use of hyper-immune serum has declined. The main reason for this is that methods for consistent manufacturing of safe hyper immune immunoglobulin products have been lacking. In contrast, manufacturing processes of recombinant monoclonal antibodies follow a well established schedule and it appears obvious to use similar methods to produce recombinant polyclonal products. However, the methods for monoclonal antibody manufacturing are, for several reasons, not directly applicable to generation and manufacture of polyclonal recombinant antibodies. A new production strategy based on recombinant mammalian producer cells has recently been developed to support consistent generation of recombinant polyclonal antibodies for therapeutic use. This review describes aspects of this novel technology with emphasis on the generation, production and characterization procedures employed, and provides comparison with alternative polyclonal and monoclonal antibody manufacturing strategies.     

Production of target-specific recombinant human polyclonal antibodies in mammalian cells

We describe the expression and consistent production of a first target-specific recombinant human polyclonal antibody. An anti-Rhesus D recombinant polyclonal antibody, Sym001, comprised of 25 unique human IgG1 antibodies, was produced by the novel Sympress expression technology. This strategy is based on site-specific integration of antibody genes in CHO cells, using the FRT/Flp-In recombinase system. This allows integration of the expression construct at the same genomic site in the host cells, thereby reducing genomic position effects. Different bioreactor batches of Sym001 displayed highly consistent manufacturing yield, antibody composition, binding potency, and functional activity. The results demonstrate that diverse recombinant human polyclonal antibody compositions can be reproducibly generated under conditions directly applicable to industrial manufacturing settings and present a first recombinant polyclonal antibody which could be used for treatment of hemolytic disease of the newborn and/or idiopathic thrombocytopenic purpura.     

儿童过敏性紫癜合并消化道出血的影响因素分析

目的:探讨过敏性紫癜合并消化道出血的相关危险因素。方法:回顾性分析2013年9月至2016年6月在武汉协和医院儿科住院治疗的80例过敏性紫癜初诊患儿的临床资料,根据是否合并消化道出血分为消化道出血组11例,非消化道出血组69例,比较两组患儿的年龄、地区、性别、发病季节、紫癜分布特征、是否合并紫癜性肾炎、hsCRP、ESR、血常规、生化等。结果:与非消化道出血组相比,消化道出血组患儿的发病季节、血清超敏C反应蛋白(hsCRP)、血清钙离子(Ca)水平差异均有统计学意义(P0.05),两组紫癜性肾炎发病率比较差异无统计学意义,但消化道出血组合并紫癜性肾炎的比例(45.5%)明显高于非消化道出血组(21.7%)。结论:夏冬季节、高水平血清CRP、低水平血清Ca~(2+)是过敏性紫癜患儿合并消化道出血的危险因素。     

FcγRI blockade and modulation for immunotherapy

 Splenectomy and corticosteroids are the treatment of choice for patients with immune thrombocytopenic purpura (ITP). However, for the 10%–15% of patients who do not respond to conventional therapy, high-dose i.v. IgG can induce life-saving transient responses. The benefits of i.v. IgG have been attributed to Fc receptor blockade; however, the involvement of the individual Fc receptors for IgG (FcγR) in ITP remain to be more completely defined. Recently a mAb, designated mAb H22, which recognizes an epitope on FcγRI (CD64) outside the ligand-binding domain, was humanized. Because mAb H22 is a human IgG1 and FcγRI has a high affinity for human IgG1 antibodies, we predicted that mAb H22 would bind to the FcγRI ligand-binding site through its Fc domain and to its external FcγRI epitope through both Fab domains. These studies demonstrate that mAb H22 blocked FcγRI-mediated phagocytosis of opsonized red blood cells more effectively than an irrelevant IgG. Moreover, cross-linking FcγRI with mAb H22 down-modulated FcγRI expression on monocytes, an effect seen within 2 h. Accepted: 14 October 1997