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이질아메바감염에 대한 면역진단법의 비교 연구

Other Titles
 Comparison of immunodiagnostic tests on entamoeba histolytica infections 
Authors
 민득영 
Issue Date
1975
Description
의학과/석사
Abstract
[한글] 이질아메바(Entamoeba histolytica)에 의한 아메바증을 진단하는데 있어서 궁극적인 방법은 본 원충을 환자의 대변 또는 해당 병소의 피검물로부터 검출하는 것이 원칙이나 실제로 그 검출은 쉽지 않다. 특히 간장 또는 기타 장외의 장기에 전이된 아메바증에 있어서는 더욱 지난한 일이다. 이러한 진단상의 난점을 극복하고져 근래에 제 면역학적 방법들이 연구 보고되고 있다. 본 연구는 아메바증환자 52명, 건강대조군 22명 및 비아메바성 각종질환자 73명의 혈청을 채취하여 간접혈구응집법(indirect hemagglutination test : IHA), 간접형광항체법(indirect fluorescent antibody test :IFA) 및 아메바제동반응(ameba immobilization test : AI)을 시행하고 그 결과를 비교하였다. IHA검사에는 Entamoeba histolytica HK-9주의 순수항원(ICN-Chemical & Redioisotope Div 제품)을 사용하였고 IFA 및 AI 검사에 사용된 항원은 YS-27주였다. 이질 아메바감염자를 아메바성 간농양, 아메바성 간염, 아메바성 폐농양, 장아메바증, 경증 장아메바증 및 무증세 「씨스트」배출자 등으로 군별하여 각 군에 있어서의 IHA, IFA 그리고 AI 검사를 시행한 바 IHA양성율은 각각 100.0%, 100.0%, 100.0%, 100.0%, 100.0% 및 90.0%였으며, IFA양성율은 100.0%, 92.8%, 100.0%, 100.0%, 90.9% 및 80.0%였고 AI양성율은 각각 91.6%, 85.9%, 100.0%, 100.0%, 81.8% 및 70.0%였다. 건강대조군의 양성율은 IHA31.8%, IFA 4.5%, AI 31.8%였다. 비아메바성 각종 질환을 간장질환, 소화기질환 및 기타 질환 등으로 군별한바 각 군에 있어서의 IHA양성율은 각각 5.8%, 20.8%, 및 44.8%였으며 IFA양성율은 17.6%, 12.5% 및 44.4%였고 AI양성율은 58.8%, 41.6% 및 70.2%였다. 각 진단법 동시 양성빈도는 임상증세별로 장외아메바증, 장아메바증, 비아메바성 간장질환, 비아메바성 소화기질환 비아메바성 기타질환 및 건강대조군으로 군별하여 조사한 바 3종검사(IHA, IFA 및 AI) 동시양성율은 각각 88.9%, 72.0%, 0.0%, 4.4%, 22.0% 및 0.0% 였으며, 2종검사(IHA와 IFA, IHA와 AI 또는 IFA와 AI) 양성율은 각각 7.4%, 24.0%, 23.5%, 12.5%, 22.2% 및 9.1%였다. 1종검사에서만의 양성율은 각각 3.7%, 0.0%, 35.3%, 37.5%, 50.0% 및 50.0%였으며 3중검사동시음성율은 0.0%, 4.0%, 41.2%, 45.8%, 5.6% 및 40.9% 였다. 이상의 결과로 미루어 (1) 3종검사법 동시 양성 혈청은 그 질환이 이질아메바에 기인됨을 의미하며, (2) 1종검사법에 양성이거나 3종검사법 동시 음성혈청은 이질아메바감염의 면역진답법상 유의성이 없으며, (3) 2종검사법 동시 양성혈청은 그 원인이 이질아메바임이 의심되지만 그 확진을 위해서는 대변검사의 임상적 고려가 필요함을 지적한다고 사료된다.
[영문] The most reliable diagnosis of Entamoeba histolytica infection is made by demonstration of the parasite from excrets or tissues of the host. However, laboratorians are used to face very often negative finding even in clinically proved cases, specially in extraintestinal types. For the reasons several immunodiagnostic methods have been developed to supplement the insufficiency; complement fixing antibody test, ameba immobilization test (Al), indirect fluorescent antibody test (IFA), soluble antigen fluorescent antibody test, gel-diffusion precipitin test, immune-electrophoresis, indirect hemagglutination test (IHA), intradermal test, bentonite flocculation tests, and latex agglutination test, etc. The present study is aimed to find more reliable and reproducible way to diagnose the infection. Among the methods, IHA, IFA and Al were chosen, and studied on the sensitivities and levels of antibody response. Serum samples were collected from 157 persons; 52 patients with proven amebic infections, 22 of apparently healthy persons, and 83 patients with miscellaneous diseases in whom Entamoeba histolytica was not proved. The IHA test was performed with Entamoeba histolytica HK-9 antigen(ICN-Chemicals & Radioisotope Div., U.S.A.) and IFA and AI tests were done with Entamoeba histolytica YS-27 antigen according to the methods described by Cho and Soh (1969). In amebic infections, positive results of 100.0, 100.0, 100.0, 100.0, 100.0, and 90.0 per cent by IHA tests, 100.0, 92.8, 100.0, 100.0, 90.9 and 80.0 per cent by IFA test, and 91.6, 85.9, 100.0, 100.0, 81.8 and 70.0 per cent by Al test were obtained in cases of amebic liver abscess, amebic hepatitis, amebic lung abscess, acute intestinal amebiasis, mild symptomatic E. histolytica cyst passers, and asymptomatic E. histolytica cyst carriers, respectively. Apparently healthy controls showed positive rates of 31.8 per cent by IHA, 4.5 per cent by IFA and 31.8 per cent by AI tests. In miscellaneous disease, positive results of 5.8, 20.8 and 44.4 per cent by IHA, 17.6, 12.5 and 44.4 per cent by IFA, and 58.8, 41.6 and 72.2 per cent by Al test were obtained in cases of liver diseases, gastrointestinal diseases and other miscellaneous diseases, respectively. The frequency of serologic test according to the clinical group revealed positive rates of 88.9, 72.0, 0.0, 4.4, 22,0 and 0.0 per cent by 3 tests(IHA, IFA and AI), 7.4, 24.0, 23.5, 12.5, 22.2 and 9.1 per cent by 2 tests(IHA & IFA, or IHA & AI, or IFA & AI), 3.7, 0.0, 35.3, 37.5, 50.0 and 5.0 per cent by only 1 test(IHA or IFA or AI), and negative results of 0.0, 4.0, 41.2, 45.8, 5.6 and 40.9 per cent, in groups of extraintestinal amebiasis, intestinal amebiasis, miscellaneous liver diseases, miscellaneous gastrointestinal diseases, other miscellaneous diseases and apparently healthy controls, respectively. The results indicated that 1) IHA, IFA and AI test positive serum would support the disease was amebic origin, 2) only 1 test positive or three tests negative serum might be clinically not significant, and 3) the two tests positive serum would need another stool examinations and clinical findings for reliable diagnosis.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/115775
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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