Secondary immunodeficiencies, including HIV infection.
Secondary immunodeficiencies, including HIV infection.
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DOI：
10.1016/j.jaci.2009.08.040
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发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Shearer WT
中科院分区：
文献类型：
--
作者：
Chinen J;Shearer WT
外在因素会对免疫反应产生不利影响，产生继发性免疫缺陷状态，从而增加感染的风险。在常规临床实践中可能遇到的这些免疫缺陷由许多条件引起，例如用糖皮质激素和免疫调节药物治疗、手术和创伤、极端环境条件和慢性感染，例如由HIV引起的那些。免疫缺陷最常见的原因是营养不良，影响到世界各地许多社区，限制获得粮食资源。蛋白质热量缺乏和微量营养素缺乏已被证明会改变免疫反应;值得注意的是，最近在维生素D缺乏导致免疫激活失败的影响方面取得了进展。其他可能出现继发性免疫缺陷的疾病包括代谢性疾病和遗传性多系统综合征。在继发性免疫缺陷中观察到的免疫缺陷在其临床表现中通常是异质性的，并且其预后取决于免疫缺陷的严重程度。原发性疾病的管理往往会导致免疫缺陷的改善;然而，这有时是不可能的，感染的风险可以通过及时的抗菌治疗和预防来降低。
Extrinsic factors can adversely affect immune responses, producing states of secondary immunodeficiency and consequent increased risk of infections. These immunodeficiencies, which can be encountered in routine clinical practice, arise from a number of conditions, such as treatment with glucocorticoids and immunomodulatory drugs, surgery and trauma, extreme environmental conditions, and chronic infections, such as those caused by HIV. The most common cause of immunodeficiency is malnutrition, affecting many communities around the world with restricted access to food resources. Protein-calorie deficiency and micronutrient deficiencies have been shown to alter immune responses; of note, recent progress has been made in the influence of vitamin D deficiency in causing failure of immune activation. Other categories of disease that might present with secondary immunodeficiency include metabolic diseases and genetic multisystemic syndromes. The immune defects observed in secondary immunodeficiency are usually heterogeneous in their clinical presentation, and their prognosis depends on the severity of the immune defect. Management of the primary condition often results in improvement of the immunodeficiency; however, this is sometimes not possible, and the risk of infections can be reduced with prompt antimicrobial treatment and prophylaxis.
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