RESUMEN
Serum alpha-antitrypsin (A1AT) was measured in 36 patients (group A) with tropical pulmonary eosinophilia (TPE) and 30 patients with pulmonary eosinophilia with associated worm infestation (group B). Serum A1AT level was also measured in 42 healthy subjects (group C). In 28 patients (group A, 15 and group B, 13), the serum A1AT level was below 60 percent of the mean A1AT value of the control group. The A1AT-deficient patients had a more severe form of illness with recurrence and relapse, and they were generally refractory to treatment. In these deficient patients, a significant negative correlation (p < 0.02) between A1AT and absolute blood eosinophil counts (AEC) was observed. In 21 patients (group A, B and group B, 13), the effect of therapy with either diethylcarbamazine or deworming or both was observed. This showed a significant posttreatment rise of A1AT level with a significant fall in AEC (p < 0.02) as compared to their respective pretreatment levels. Serum A1AT levels in either or both parents of 11 patients (group A, 5 and group B, 6) were found to be within normal levels. The significant rise in A1AT levels with a significant fall in AEC levels in the patients following therapy and the absence of A1AT deficiency in the parents examined indicate that the A1AT deficiency observed in TPE is probably acquired.
Asunto(s)
Eosinofilia Pulmonar/sangre , Deficiencia de alfa 1-Antitripsina , Adulto , Dietilcarbamazina/uso terapéutico , Eosinófilos , Femenino , Helmintiasis/complicaciones , Helmintiasis/tratamiento farmacológico , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Eosinofilia Pulmonar/complicaciones , alfa 1-Antitripsina/genéticaRESUMEN
An evaluation of the usefulness of urinary N-acetyl-beta-D-glucosaminidase (NAG) and aminopeptidase N (AAP) measurements in the diagnosis and prediction of acute and chronic renal allograft rejection was made. Enzyme activities were measured in 2,745 morning spot urine samples from 53 consecutive live donor renal allograft recipients up to 180 days after transplantation. Reference ranges of urinary enzyme activities in 14 recipients with normal graft function were higher than those established in a carefully selected group of healthy controls. 89 and 91% of 76 clinically diagnosed acute rejection episodes (ARE) in the remaining 39 graft recipients were accompanied by sharp increase over baseline of NAG and AAP respectively. All rejection episodes occurring in the early period after transplantation were characterised by high enzymuria. AAP was more sensitive than NAG as the magnitude of its increase over baseline was more, while NAG was more specific with less number of false positive elevations. Both enzymes were found to be equally good prognostic indices of graft loss and chronic graft deterioration. Regular monitoring of urinary NAG and AAP activities throughout the post transplant period would thus be valuable in (a) diagnosis and prediction of ARE in the early as well as late post operative period and (b) prediction of eventual graft outcome.