Gaweł Józef, Pogorzelski Andrzej, Działek-Smętek Ewa, Sochań Beata, Ligarska Renata, Lącka Maria, Mazurek Henryk
Pneumonol Alergol Pol. 2014;82(4):336-41. doi: 10.5603/PiAP.2014.0042.
Eradication of Pseudomonas aeruginosa (P.a.) in patients with cystic fibrosis (CF) is possible if it is initiated in the early course of infection. Therefore, the detection of P.a. as early as possible is an important goal of care. Regular determination of antibodies to P.a. antigens in serum may be useful in patients who have not yet been infected or were infected intermittently. The aim of the present study was to assess the concentrations of antibodies to selected antigens of P. aeruginosa in the serum of children with CF and with known status of P.a. infection.
The study was performed in 111 CF patients (27 not infected with P. aeruginosa, 29 with intermittent infection and 55 with chronic infection). The concentrations of IgG antibodies to the alkaline protease (AP), elastase (ELA) and exotoxin A (Exo-A) were measured. The increased concentration of antibodies was defined as exceeding 500 units (according to the manufacturer). The results of antibodies assessment were analysed according to previous infection status and the results of present culture.
At the time of the study, P.a. was cultured from sputum of 57 patients: 9 out of 29 (31%) with intermittent infection, and 48 out of 55 (87%) with chronic infection. Increased concentrations of antibodies to one or more P.a. antigens were found in 60 patients, and to all three types of antigens in 30 patients. Increased serum antibody concentration was found significantly more often in the patients with chronic P.a. infection compared to those with intermittent infection (82% vs. 35%, p = 0.0001). In the patients with chronic P.a. infection (especially with mucoid type), serum antibody concentrations were significantly higher than in other patients. Higher concentrations of antibodies were also found in the patients with positive result of P.a. culture at the time of the study, compared to those with negative culture. In 19% of patients not infected with P.a., increased serum antibodies to at least one P.a. antigen were found. The clinical significance of such findings is unclear and needs further investigation.
In the present study, the increased serum concentrations of IgG antibodies to P. aeruginosa antigens (AP, ELA and Exo-A) were found most often in the patients with chronic P.a. infection and in those in whom P.a. (especially mucoid type) was cultured at the time of the study. The clinical significance of the elevated antipseudomonal antibodies level in 19% of the patients never infected with P.a. is unclear and needs further investigation.
如果在囊性纤维化（CF）患者感染的早期阶段就开始治疗，根除铜绿假单胞菌（P.a.）是有可能的。因此，尽早检测出P.a.是护理的一个重要目标。对于尚未感染或间歇性感染的患者，定期测定血清中针对P.a.抗原的抗体可能会有所帮助。本研究的目的是评估已知P.a.感染状况的CF儿童血清中针对铜绿假单胞菌选定抗原的抗体浓度。
该研究对111例CF患者进行（27例未感染铜绿假单胞菌，29例间歇性感染，55例慢性感染）。测定了针对碱性蛋白酶（AP）、弹性蛋白酶（ELA）和外毒素A（Exo-A）的IgG抗体浓度。抗体浓度升高定义为超过500单位（根据制造商规定）。根据既往感染状况和当前培养结果分析抗体评估结果。
在研究时，从57例患者的痰液中培养出P.a.：29例间歇性感染患者中有9例（31%），55例慢性感染患者中有48例（87%）。60例患者发现一种或多种P.a.抗原抗体浓度升高，30例患者三种抗原抗体浓度均升高。与间歇性感染患者相比，慢性P.a.感染患者血清抗体浓度升高的情况明显更常见（82%对35%，p = 0.0001）。在慢性P.a.感染患者（尤其是黏液型）中，血清抗体浓度明显高于其他患者。与培养结果为阴性的患者相比，研究时P.a.培养结果为阳性的患者抗体浓度也更高。在19%未感染P.a.的患者中，发现至少一种P.a.抗原的血清抗体升高。这些发现的临床意义尚不清楚，需要进一步研究。
在本研究中，血清中针对铜绿假单胞菌抗原（AP、ELA和Exo-A）的IgG抗体浓度升高最常见于慢性P.a.感染患者以及研究时培养出P.a.（尤其是黏液型）的患者。19%从未感染过P.a.的患者中抗铜绿假单胞菌抗体水平升高的临床意义尚不清楚，需要进一步研究。
