免疫功能检查解读.ppt

小结 1．免疫球蛋白升高可见于肝病、自身免疫病、慢性感染、恶性肿瘤、免疫母细胞淋巴结病及AIDS等； 2．单克隆性免疫球蛋白又称M蛋白，主要见于多发性骨髓瘤、巨球蛋白血症、轻链病、重链病等。 3．补体降低主要见于各种补体合成能力下降性疾病如慢性肝病、补体合成原料不足如营养不良、补体消耗或丢失太多如各种自身免疫性疾病及先天性补体缺乏等。 4. 细胞免疫功能主要采用流式细胞技术检测活性细胞表面标志。细胞因子谱的检测有利于反映T细胞活化亚群功能及活性。 复习思考 1．免疫球蛋白升高的临床意义 2．M蛋白的实验室特征 3．补体检测的临床意义 4．CD4、CD8及其比值的临床意义 免疫印迹 免疫沉淀 免疫固定电泳 Clinical manifestations l?? Bone pain: 2/3 l??? Height reduce because of vertebral collapse l??? Weakness and fatigue because of anemia l??? Fever because of infectious process l??? Pallor, most frequent physical finding l? Liver palpable in 15% patients, spleen rarely enlarged l?Extramedullary plasmacytomas: large, purplish, subcutaneous masses observed late in the course of the disease Laboratory findings L Normocytic, normochromic anemia 2/3 L Hypercalcemia L Elevation of serum creatinine level L SPE: M-spike 80% L M-protein: 92% IgG 50%; IgA 20%; free monoclonal light chain 20% L Serum or Urine M protein: 99% L Plasma cells: 10% (5~100%), more focal than diffuse, repeated bone marrow examination necessary Helpful laboratory items for differential diagnosis: The size of the serum M-protein; The amount of urine M-protein; The number of bone marrow plasma cells; The hemoglobin, calcium, and creatinin levels and levels of uninvolved serum Igs; Prognostic factors l? Duration of survival: few months ~ many years, median 2.5~3 year. l?? Uncorrected β2 microglobulin level is one of the most powerful prognostic factors l? CRP, which correlated with the serum IL-6 level maybe helpful for determining prognosis l???? LDH, if elevated indicates poor prognosis 单克隆性免疫球蛋白增殖症的实验室诊断要点 免疫球蛋白及轻链定量 血清蛋白电泳 免疫固定电泳 尿蛋白电泳及本周氏蛋白定性 补体检查和有关疾病 总补体活性测定 CH50 单个补体成分定量 C4－经典途径 B因子－旁路途径 C3－经典和旁路途径 临床意义： 补体减少：肾病、自身免疫性疾病、肿瘤、 补体缺陷病。 补体增加：少见，如肿瘤。 Two Typical Pathway for Complement Activation Common Pathway for complement activation 补体与肝脏的关系较免疫球蛋白更为密切，部分补体及其抑制因子由肝脏合成，肝脏的感染和炎症反应可刺激机体免疫系统，导致血清总补体活性及其它