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매독 환자의 병변에서 면역과산화효소법을 이용한 Treponema pallidum 검출에 관한 연구

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 Detection of treponema pallidum in tissues by the avidin-biotin-peroxidase complex and the indirect immunoperoxidase techniques 
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[한글]조직내에서 매독균을 검출하는 방법에는 암시야 검사, 은포화염색( silver impregnation )법, 면역형광법, 면역과산화효소법 및 전자현미경을 이용하는 방법등이 있으나, 이 중에서 면역형광법 및 면역과산화효소법이 높은 감수성을 보이는 것으로 알려져 있다. 연구 자는 병력, VDRL, FTA-ABS, TPHA 및 19s ( ⅠgM )-FTA검사로 확진된 1기 및 2기 매독환자 30명에서 채취한 36개의 피부병변과, 위장매독이 의심되는 환자에서 채취한 1개의 위점막병변에서 매독균인 T.pallidum을 검출하기 위하여 avidin-biotin-peroxidase complex (ABC)법과 간접 면역과산화효소법 (indirect immunoperoxidase technique)을 시행하여, 암시야 검사법의 결과와 비교하여 다음과 같은 결과를 얻었다. 1. ABC법을 시행한 37개의 병변중 35개(95%)에서, 간접 면역과산화효소법으로 37개의 병변중 33개(89%)에서 매독균이 검출되었고, 암시야 검사법으로는 17개의 병변중 12개(71%)에서 매독균이 검출되었다. 2기 매독병변에서 ABC법과 암시야 검사법의 결과 사이에는 통계학적으로 유의한 차이가 있었다 ( P<0.05). 2. ABC법과 간접 면역과산화효소법의 일치도는 89%였으며, ABC법과 암시야 검사법의 일치도는 76%였고, 간접 면역과산화효소법과 암시야 검사법의 일치도는 82%였다. 3. 매독균은 피부병변내에서, 상부진피에 가장 많이 분포되어 있었고, 표피, 혈관벽, 하부진피의 순으로 많이 분포되어 있었다. 그러나 1기 매독병변과, 2기 매독병변중 반점, 구진 및 편평콘딜롬 등의 병변형태에 따른 조직내 매독균 분포빈도에는 뚜렷한 차이가 없었다. 이상의 결과로, 면역과산화효소법 특히 ABC법은 매독병변에서 매독균을 확인하는데 매우 우수한 방법이라고 생각된다.
[영문]Several methods have been developed for detecting T. pallidum in syphilitic lesions, namely, the darkfield examination, silver impregnation, immunofluorescence, immunoperoxidase techniques and the electron microscopy. Among them, the immunofluorescence and immunoperoxidase techniques provide a far greater degree of sensitivity and specificity than any other method. Using the avidin-biotin-peroxidase complex(ABC) and the indirect immunoperoxidase techniques, 36 skin specimens from 30 patients with primary and secondary syphilis, and a gastric mucosal specimen from a patient with suspected gastric syphilis which were confirmed by clinical history, physical examination, the VDRL, FTA-ABS, TPHA, and 19s(IgM)-FTA tests were examined. The results of the ABC and the indirect immunoperoxidase techniques were compared with that of the darkfield examination. The following results were obtained: 1. 0f the 37 specimens, 35(95%) were positive in the ABC technique and 33 of the 37 specimens (89%) were positive in the indirect immunoperoxidase technique. Of the 17 specimens, 12(71%) were positive in the darkfield examination. There was statistical significance between the results of the ABC technique and darkfield examination in the secondary syphilitic lesions (P<0.05). 2. The ratio of agreement of the results between the ABC and the indirect immunoperoxidase techniques was 89%. The ratio of agreement of the results between the ABC technique and the darkfield examination was 76%. The ratio of agreement of the results between the indirect immunoperoxidase technique and the darkfield examination was 82%. 3. Most of the treponemes were located in the upper dermis, epidermis, and blood vessel walls in the order named, and rarely in the lower dermis of the syphilitic skin lesions. There was no remarkable difference in histologic distribution of treponemes between the clinical stages and types of syphilitic skin lesions. From the results, the immunoperoxidase technique especially the ABC technique is considered to be an excellent method for detecting the treponemes in the suspected syphilitic lesions.
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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