探討呼吸照護病房患者對常見感染性細菌性蛋白之IgE反應特性

呼吸照護病房及慢性病房來自安養機構之病患常屬於長期臥床的狀態，在這些長期臥床的病患除了固有的內科疾病，也常伴隨各式各樣的細菌性感染，因而造成細菌性肺炎、泌尿道感染及菌血症。我們已知IgE抗體主要與過敏反應相關，而IgG與IgM則與入侵的病原體辨識及清除有關。過去已鑑定與熟知的過敏原絕大多數為真核細胞組成，包括蛋白質與複合型多醣體，然而細菌性抗原除了造成常見的發炎反應之外，是否也會引起過敏反應則鮮少被探討。因此，本研究的目的擬探討呼吸照護病房患者對常見感染性細菌性蛋白之IgE反應特性，以探討細菌性抗原是否有致敏的可能。我們篩選出來自呼吸照護病房11位肺炎患者以及慢性病房2位肺炎患者共13位受試者的臨床資料與血清進行檢驗資料與IgE的分析。我們先小量培養最常見的兩株院內肺炎致病菌，綠膿桿菌（Pseudomonas aeruginosa）和克雷伯氏肺炎桿菌（Klebsiella pneumonia），再破菌萃取出細菌蛋白，接著使用西方墨點法，分析這13位受試者血清中的IgE與萃取的細菌蛋白的反應情形。分析結果顯示有血清IgE主要辨識8個細菌性蛋白，其分子量範圍為17-45 kDa。其中，分子量大小為35 kDa的細菌性蛋白可被全部13位受試者的血清IgE所辨識。在臨床資料分析部分，我們發現13位受試者白血球計數WBC (white blood cell) count及嗜酸性白血球(Eosinophil)歷次檢驗報告皆呈高值參數，部分病患的嗜中性白血球(Neutrophil)歷次檢驗報告呈高值參數，白血球計數呈高值呼應的是病患正處於發炎狀態，在白血球總量呈現高值的狀況下伴隨著嗜中性白血球高值，呼應病患正處於細菌性感染並且發炎的狀態，而嗜酸性白血球高值呼應病人屬於過敏狀態，從臨床資料分析加上西方墨點法結果，合理懷疑受試者因細菌性肺炎的病程導致這些細菌性抗原有致敏化的可能，細菌性抗原的致敏化使受試者血清IgE能辨識其蛋白。

關鍵字

呼吸照護病房；肺炎感染菌；抗生素；第一型過敏反應； IgE抗體；臨床檢驗；嗜酸性白血球；過敏原

並列摘要

Respiratory care wards and chronic diseases wards patients from nursing home are regularly in a state of long-term bedridden. In addition to the inherent internal diseases, these long-term bedridden patients. Also regularly accompanied by a variety of bacterial infections. Thus causing bacterial pneumonia, urinary tract infections and bacteremia. We know that IgE antibodies are mainly related to allergic reactions and IgG and IgM are related to the identification and clearing away of invading pathogens. The most of allergens identified and known in the past study are composed of eukaryotic cells that including protein and complex polysaccharide. However, in addition to the common inflammation caused by bacterial antigens, whether bacterial antigens can also causing allergic reactions is rarely discussed. Therefore, the object of this study is investigation of IgE-reactivity to bacterial proteins in the patients with bacterial infection from Respiratory Care Ward. To investigate the possibility of bacterial antigen sensitization. We selected clinical data and sera from 11 patients with bacterial pneumonia in the respiratory care wards and 2 patients with bacterial pneumonia in the chronic diseases ward for clinical test data and analysis of IgE. We subculture the two common pathogen including Pseudomonas aeruginosa and Klebsiella pneumonia of Nosocomial pneumonia pathogens. Then break the bacteria to extract the bacterial protein, and analyzed by the Western blot method. Analysis reaction of IgE in the serum of these 13 subjects with the extracted bacterial protein. Analysis results show that IgE of serum target recognize 8 bacterial proteins with a molecular weight range of 17-45 kDa. In between, bacterial protein with a molecular weight of 35 kDa can be recognized by serum IgE of all 13 subjects. In the analysis of clinical data, we found that 13 subject WBC (white blood cell) count and Eosinophil count medical records showed high value parameters. Some patient neutrophil medical records showed high value parameters. The high value parameters of white blood cell count showed that the patient is in a state of inflammation. When the white blood cells count is high value parameter and accompanied by a high value of neutrophils, which showed that the patient is in a state of bacterial infection and inflammation. The high value parameters of eosinophils count showed that the patient is in a state of allergy. Basing on the analysis of clinical data and Western blotting results, we suggest that the subjects with bacterial pneumonia might promote the sensitization to these bacterial antigens, and the promoted sensitization of bacterial antigens may subsequently induce the production of IgE specifically react to the bacterial proteins.