中华皮肤科杂志 ›› 2004, Vol. 37 ›› Issue (9): 537-539.

• 论著 • 上一篇    下一篇

用ND-ELISA检测已治愈的麻风患者血中IgM抗体水平

吴勤学1, 张良芬1, 陈小红1, 尹跃平1, 余艳华1, 李志诚2, 郁华2, 史月君3, 吕成志3, 林钧伦3, 冯素英1, 李晓杰1   

  1. 1. 中国医学科学院、中国协和医科大学皮肤病研究所, 南京210042;
    2. 甘肃省疾病预防控制中心麻风病研究室;
    3. 大连市皮肤病防治所
  • 收稿日期:2003-09-24 出版日期:2004-09-15 发布日期:2004-09-15
  • 基金资助:
    国家自然科学基金资助课题(39670680)

Detecting Serum IgM-antibody in Cured Leprosy Patients by ND-ELISA: A Result of Three-Year Followe up

WU Qin-xue1, ZHANG Liang-fen1, CHEN Xiao-hong1, YIN Yue-ping1, YU Yan-hua1, LI Zhi-cheng2, YU Hua2, SHI Yue-jun3, LU Cheng-zhi3, LIN Jun-lun3, FENG Su-ying1, LI Xiao-jie1   

  1. Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing 210042, China
  • Received:2003-09-24 Online:2004-09-15 Published:2004-09-15

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摘要： 目的 探讨用血清学方法检测麻风早期复发的可能性。方法 用标准化的ND-ELISA连续检测氨苯砜(DDS)单疗愈后麻风患者血清中抗ND-IgM型抗体的变化,与麻风临床复发患者进行比较。结果 受检DDS单疗愈后麻风患者共666例,其中原多菌型患者(P-MB)430例,原少菌型患者(P-PB)236例,共复发15例。在P-MB中,抗体阳性者95例,复发12例,抗体阴性者335例,复发1例;在P-PB中,抗体阳性44例,复发1例,抗体阴性192例,复发1例。P-MB引起复发的危险比P-PB高6.7倍;累积复发率(CRR)表明:抗体阳性组复发率为13.68%,抗体阴性组复发率为0.35%,其相对危险率(RR)为36.7(RR>1),特异危险度(AR)为13.33%;复发时绝大多数抗体为阳性,从治愈后到复发绝大多数抗体呈上升趋势或持续阳性,复发后经有效治疗绝大多数抗体水平逐渐下降,抗体阳性后1-2年发生复发(多为2年后);治愈后到复发多在10年以后发生(11~30年),未见有高峰年段;个别复发者发生降级性转型(TT→BT)。DDS单疗治愈后的P-MB、P-PB中不论抗体阳性还是阴性均能产生复发,但在P-MB引起复发的危险性明显高于P-PB(6.7倍),抗体阳性者危险性明显高于抗体阴性者(36.7倍);在复发时绝大多数抗体为阳性。结论 检测和监测DDS单疗治愈后麻风患者血清中抗ND-IgM型抗体水平能预测其复发的危险性,ND-ELISA在预测早期麻风复发中有实用价值,特别是对多菌型复发.

关键词: 麻风, 复发, 酶联免疫吸附测定

Abstract: Objective To investigate the possibility of detecting relapse of leprosy early by immuno-serological method. Methods Indirect enzyme-linked immunosorbent assay(ELISA) using natural disaccharide octyl bovine serum albumin (ND-O-BSA) as an antigen(i.e. ND-IgM-ELISA or ND-ELISA) to detect antibody against ND in the sera from normal controls, and to detect the change of antibody level in the sera from cured leprosy and from relapsed leprosy patients. Results A total of 666 cured leprosy patients treated with DDS monotherapy, including 430 cases of multi-bacillary patients(P-MB), 236 cases of pauci-bacillary patients(P-PB), and 15 of them were relapsed, their IgM antibody levels (IgM-AbL) were periodically determined by using above ND-ELISA. The results showed that after DDS monotherapy: ①In MB patients, 95 were Ab positive, 12 of them were diagnosed as relapsed leprosy; 335 cases were Ab negative, only 1 of them was diagnosed as relapsed leprosy; ②In PB patients, 44 were Ab positive and 192 cases Ab negative; 1 case of relapsed leprosy was found; ③The risk of relapse was 6.7 times higher in MB patients than that in PB patients; ④In the group with positive Ab, the cumulative rate of relapse(CRR) was 13.68%, in the group of negative Ab, the CRR was 0.35%, the risk ratio (RR)=36.7(RR>1), attributable risk (AR)=13.33%; ⑤Even though the serum specimens were taken from PB patients, the Ab of majouity of patients converted to positive when relapse occurred. In the majority of patients relapsed the levels of IgM-AbL tended to be increasing or pesistently positive. Usually relapse occurred 1-2 years after IgM-AbL was converted to positive. Relapse occurred 11-30 years after the patients were cured. In very rare case downgrading(from tuberculous to borderline leprosy) occurred. ⑥The levels of IgM-AbL gradually decreased in all relapsed patients after effective treatment except one case whose IgM-AbL was persistently positive. Conclusions The above results indicate that the ND-ELISA might be useful in screening early M.leprae infection and in predicting and monitoring the relapse of leprosy, especially in multibacillary patients.

Key words: Leprosy, Recurrence, Enzyme-linked immunosorbent assay