Müller C, Wolf H, Göttlicher J, Zielinski C C, Eibl M M
Department of Gastroenterology and Hepatology, University of Vienna, Austria.
Dig Dis Sci. 1991 Jan;36(1):116-22. doi: 10.1007/BF01300099.
Cellular immunological abnormalities were studied in a patient with protein-losing enteropathy associated with constrictive pericarditis. Analysis of lymphocyte subpopulations in peripheral blood showed lymphopenia with a decrease of CD3+ and CD4+ T cells, whereas CD8+ lymphocytes, B cells and NK cells were within the normal range. Fecal loss of lymphocytes as a cause of lymphopenia was evidenced by a marked excretion of 111-indium-labeled peripheral blood mononuclear cells via stool. Proliferative responses against several mitogens were severely reduced as was in vitro IgG production. Delayed-type hypersensitivity reaction against a variety of antigens was absent. Vaccination with tick-borne encephalitis virus, used for primary immunization, and with the recall antigen tetanus toxoid resulted in a blunted antibody response. After pericardectomy, the severity of enteric protein loss declined, serum immunoglobulin levels returned to the normal range, and total lymphocytes and CD3+ and CD4+ counts increased but remained low even 12 months after surgery. Fecal loss of lymphocytes was found to be reduced after pericardectomy, but was higher than that seen in a disease control patient with active inflammatory bowel disease. In vitro immunoglobulin production returned to normal, DTH could be demonstrated against purified protein derivative and proteus antigen, but mitogen-driven blastogenic response of lymphocytes remained low. Revaccination with tick-borne encephalitis and tetanus toxoid antigens seven months after surgery resulted in a dramatic increase of serum levels of antibodies against both antigens, comparable to that seen in healthy control individuals.(ABSTRACT TRUNCATED AT 250 WORDS)
对一名患有与缩窄性心包炎相关的蛋白丢失性肠病患者的细胞免疫异常进行了研究。对外周血淋巴细胞亚群的分析显示淋巴细胞减少，CD3⁺和CD4⁺T细胞减少，而CD8⁺淋巴细胞、B细胞和NK细胞在正常范围内。粪便中淋巴细胞丢失作为淋巴细胞减少的原因，通过粪便中显著排泄¹¹¹铟标记的外周血单核细胞得到证实。对几种有丝分裂原的增殖反应严重降低，体外IgG产生也如此。对多种抗原的迟发型超敏反应缺失。用蜱传脑炎病毒进行初次免疫接种以及用回忆抗原破伤风类毒素接种，导致抗体反应减弱。心包切除术后，肠道蛋白丢失的严重程度下降，血清免疫球蛋白水平恢复到正常范围，总淋巴细胞以及CD3⁺和CD4⁺细胞计数增加，但即使在手术后12个月仍保持较低水平。心包切除术后发现粪便中淋巴细胞丢失减少，但高于患有活动性炎症性肠病的疾病对照患者。体外免疫球蛋白产生恢复正常，可以证明对纯化蛋白衍生物和变形杆菌抗原有迟发型超敏反应，但淋巴细胞的有丝分裂原驱动的增殖反应仍然较低。手术后七个月用蜱传脑炎和破伤风类毒素抗原再次接种，导致针对这两种抗原的血清抗体水平急剧升高，与健康对照个体所见相当。（摘要截短至250字）
