Using Intravenous Immunoglobulin (IVIG) to Treat Patients with Primary Immune Deficiency Disease
Using Intravenous Immunoglobulin (IVIG) to Treat Patients with Primary Immune Deficiency Disease
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DOI：
10.1007/s10875-012-9838-1
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发表时间：
2013-01-01
影响因子：
9.1
通讯作者：
Bonagura, Vincent R.
中科院分区：
文献类型：
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作者：
Bonagura, Vincent R.
从健康对照中获得的免疫球蛋白静脉注射治疗原发性免疫缺陷病（PIDD）患者，是一个相对较新的事件，于1981年首次使用。静脉注射免疫球蛋白（IVIG）替代PIDD已被证明可以预防严重/复发性感染，因为通过静脉注射可以获得更高的IgG水平，而不是肌肉注射途径。对照组中IgG水平的显著差异取决于年龄和性别，这为PIDD中存在“生物IgG低谷/水平”（以下称为生物IgG水平）这一概念提供了依据，因为健康对照组中也存在这一概念。每个PIDD患者都有一个IgG生物学水平，可被引起IgG丢失或代谢/分解代谢改变的合并症所改变。IVIG与SCIG的药代动力学比较显示了各自治疗PIDD的各种益处。急性PIDD患者应该只接受IVIG。“Rush”SCIG治疗也可用于达到生物IgG水平，但对于PIDD的紧急护理较少。最后，未来有机会增强PIDD中IgG的替代，包括微生物特异性IgG和IgG亚类特异性富集制剂。
The treatment of primary immunodeficiency disease (PIDD) patients with immunoglobulin obtained from healthy controls, given intravenously, is a relatively recent event, having first been given in 1981. Intravenous immunoglobulin (IVIG) replacement in PIDD has been shown to prevent serious/recurrent infections because higher IgG levels can be obtained through IV administration, as opposed to the intramuscular route. Significant variation in IgG levels in controls is dependent on age and sex, which provides the rationale for the concept that there is a "biological IgG trough/level", hereafter called biological IgG level, in PIDD, as there is in healthy controls. Each PIDD patient has a biological IgG level that can be altered by comorbid conditions that evoke IgG loss or changes in metabolism/catabolism. The pharmacokinetic comparison of IVIG vs. SCIG demonstrates the various benefits of each in treating PIDD. Acutely ill PIDD patients should only receive IVIG. "Rush" SCIG treatment can also be used to attain the biological IgG level, but for less emergent care of PIDD. Finally, future opportunities exist to enhance IgG replacement in PIDD, including microbe-specific IgG and IgG subclass-specific enriched preparations.