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本文研究1例 IgG-IgA 混合型慢性冷凝集索病的免疫球蛋白分类及其溶血机制。患者原有慢性贫血,为产后贫血加重而入院;检查发现冷凝集效价高达16,384并有较高温度反应范围,其血清经2-ME 处理冷凝集效价不变表明其抗体不是 IgM。从红细胞洗脱浓缩之冷凝集素经免疫电泳等研究证实为 K 链 IgG-IgA 混合型。用抗-IgG、抗-IgA、抗-C_3血清做特异性Coombs 试验均阳性,仅抗-IgM 血清为阴性,以冷凝集素提取液做补体结合试验亦为阳性,这些结果提示本例 IgG-IgA 型冷凝集素反应时可激活补体系统。患者肝索化血在4℃下尚可见单核细胞与红细胞形成自然玫瑰花结,这似乎是致敏红细胞与单核细胞的 Fc 及 C_3受体作用的结果。投与强的松后溶血改善,并以日服20 mg 维持量维持缓解。
In this paper, immunoglobulin classification and hemolytic mechanism of one case of IgG-IgA mixed chronic cold-condensing disease were studied. Patients with chronic anemia, post-natal anemia increased hospitalization; examination showed that the condensate titer up to 16,384 and a higher temperature reaction range, the serum titer unchanged by 2-ME treatment showed that the antibody is not IgM. Concentration of cold agglutinin eluted from erythrocytes by immunoelectrophoresis and other studies confirmed that K chain IgG-IgA mixed type. Specific anti-IgG, anti-IgA, anti-C3 serum specific Coombs test were positive, only anti-IgM serum was negative to cold agglutinin extract complement test was also positive, these results suggest that this case of IgG- IgA-type cold agglutinin reaction can activate the complement system. Hepatic cord blood of patients at 4 ℃ is still visible monocytes and erythrocytes to form a natural rosette, which seems to be sensitized erythrocyte and monocyte Fc and C_3 receptor results. After administration of prednisone hemolysis improved, and to maintain the amount of 20 mg on the maintenance of relief.