抗原抗体反應と白血球像研究補遺(第3報) 所謂吉田氏反応の発現機序に就て

Abstract

Bovce, Harris及びVestによる踵位膀胱撮影法(DorsalCystography)の術式を述べ, 本法を応用して膀胱及び前立腺腫瘍, 神経因性膀胱, 膀胱憩室等に於て, 正常の背位等の方法では発見出来ない, 或は不明瞭な膀胱憩室, 尿管逆流現i象, 膀胱憩室等を描出した.更に経腰的腎孟撮影法を併用して骨盤部尿管狭窄及び結石の部位と膀胱との位置的関係を明示した.

It was reported in the first report of this series that in the majority of urogenital tuberculosis a transient leucopenia was brought about when a small quantity of tuberculous vaccine or tuberculin was injected subcutaneously. It was reported also that this phenomenon disappeared several weeks after the removal of the cardinal tuberculous lesions, even if the tuberculin reaction preserves the same intensity. In the second report, the change in the leucocytes count due to a reinjection of the same antigen in sensitized rabbits was described. The antigens employed were typhoid vaccine, human serum, BCG and purified variola vaccine (the animals sensitized with BCG were reinjected with tuberculin). The dosage of the second injection was so small that it did not influence on the leucocytes count in nonsensitized rabbits. Nevertheless, a transient leucopenia appeared in the majority of the sensitized rabbits by such antigens as typhoid vaccine and the human serum which were considered to produce humoral type of antibodies. On the contrary, the leucopenia appeared only in a small number of the sensitized rabbits by such antigens as BCG and purified variola vaccine which were considered to produce mainly tissue antibodies. These facts indicated that such a transient leucopenia might only be caused by an antigen-antibody reaction in body fluid. The present study aimed to make clear the mechanism of such a transient leucopenia. For this purpose, the problem was studied first as to whether the crystalline egg-albumin (in small dosage) would cause such a leucopenia in rabbits which had been passively sensitized by a transfusion of serum obtained from actively sensitized rabbits by the same antigen. Then the influence on the leucopenia thus produced of anti-histamine and anti-plasmin was studied. The influence on the leucocytes count of the precipitate was studied also which was produced by an antigen-antibody reaction in vitro and was injected into normal rabbits. As a clinical study, it was investigated the influence of anti-histamine and anti-plasmin on Yoshida's reaction, a transient leucopenia which was brought about in patients of uro-genital tuberculosis by an injection of tuberculin. Thus the following results were obtained: 1) A recognizable change in the leucocytes count was not demonstrated in the streaming blood of normal rabbits when 0.1% solution of crystalline egg-white albumin or anti-serum (0.2 ml/kg) was intravenously injected. 2) A significant leucopenia was temporarily brought about, however, when the same antigen was introduced in the same way into rabbits which had passively sensitized with anti-serum against the same antigen. The leucopenia appeared less pronounced, however, when the same antigen was given again 21 hours after the first injection. 3) A greater leucopenia with a longer duration was brought about when a serum with a higher precipitation titer was employed in the passive sensitization. 4) The leucopenia in actively sensitized animals seemed to be impeded by anti-histamine to some extent, while that in passively sensitized animals did not seem to be impeded to any extent. 5) A slight leucopenia was temporarily brought about by an injection of histamine but it was complately inhibited by antihistamine injected simultaneously. 6)The leucopenia in passively sensitized animals was not inhibited by anti-plasmin injected simultaneously. 7) The transient leucopenia was brought about when a small quantity of precipitate (produced by an antigen-antibody reaction in vitro) was intravenously injected into normal rabbits, and the leucopenia was not inhibited by anti-histamine. A slight but typical leucopenia was also brought about when such precipitate was used as produced by mixing highly diluted antigen with antibody at the most adequate ratio. 8) Yoshida's reaction by tuberculin in patients of uro-genital tuberculosis was not inhibited by anti-histamine or anti-plasmin. The following conclusions were derived from the present data as well as those reported previously as the first and second report of this series. 1) A transient leucopenia with is brought about in tuberculous patients when a small dosage of tuberculous vaccine or old tuberclin is subcutaneously injected, and which is known as Yoshida's reaction, is caused by an antigen-antibody reac-between tuberculin and the humoral antibody in the serum of the patients. It has, tion therefore, no relation with the tissue antibodies which cause the cutaneous reaction known as tuberculin reaction. For this reason, Yoshida's reaction does not appear paraller with the intracutaneous tuberculin reaction. 2) Positivity of Yoshida's reaction may be influenced by the amount of tuberculous antibodies in the serum, for a leucopenia is of higher degree and of logger duration when the precipitin titer is higher as indicated by the experiment with eggalbumin. An increase in the intensity of Yoshida's reaction may, therefore, indicate an increase in the titer of serum precipitin against tuberculous antigen of the respective patient; thus, probably, an increase in the activity of the tuberculoss lesion. 3) Yoshida states that his reaction can be employed in the differentiation of tuberculous diseases from others, and in the estimation of the activity of tubercuous lesions and of prognosis. The present auther considers that the results of his experiments corroborate Yoshida's assertion.