Cell-mediated immunity in healthy and uremic adults assessed by in vivo and in vitro techniques. Validation of delayed hypersensitivity skin testing.
Cell-mediated immunocompetence was assessed in 16 healthy and 10 uremic subjects by "in vivo" and "in vitro" techniques, simultaneously. PHA-induced lymphocyte transformation, Multitest and classical skin testing with a panel of 7 antigens have been used. Similar cutaneous delayed-type hypersensitivity (DTH) results were obtained when using either Multitest or the classical panel, both in healthy subjects (R = 0.66) and in uremic patients (R = 0.61). The results were the same for both the total scores and the number of positive responses per subject. The two DTH methods were of similar accuracy in the evaluation of normal DTH responses and hypoergy in both populations but the sensitivity in detecting anergy among the uremics was higher for the classical panel (80%) than for Multitest (60%). However, no method proved to be more prone to classify a healthy subject as anergic. Anergy was more frequent among uremic patients both with Multitest (60%) and the conventional panel (80%) but was unusual among healthy controls (6.3% and 7.1%, respectively) (p less than 0.0001 for both). Depressed DTH reactivity in uremia was correlated with longer blood transfusion-free intervals (p less than 0.05) and influenced by the duration of haemodyalisis and the number of blood transfusions. Similar CMI impairment rates were found in uremic patients with Multitest (76.9%), the classical panel (63.8%) and "in vitro" techniques (63.7%). Therefore, cutaneous DTH testing proved to be a useful mean of evaluating CMI. Moreover, the high cost and technical complexity of "in vitro" techniques are major drawbacks against their use and strenghthen the role of DTH skin testing as a useful clinical tool to measure CMI.(ABSTRACT TRUNCATED AT 250 WORDS)
López
M
M
Sección de Alergologia, Hospital Marqués de Valdecilla, Santander, Spain.
Jerez
J
J
González
M
M
Arias
M
M
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002478:Cells, Cultured; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology*; D007111:Immunity, Cellular; D007153:Immunologic Deficiency Syndromes / Q000175:diagnosis / Q000209:etiology / Q000276:immunology*; D007428:Intradermal Tests / Q000379:methods; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012882:Skin Tests / Q000379:methods; D014511:Uremia / Q000150:complications / Q000276:immunology* / Q000628:therapy