Impact of trough IgG on pneumonia incidence in primary immunodeficiency: A meta-analysis of clinical studies
Impact of trough IgG on pneumonia incidence in primary immunodeficiency: A meta-analysis of clinical studies
复制标题
DOI：
10.1016/j.clim.2010.06.012
复制
发表时间：
2010-10-01
影响因子：
8.6
通讯作者：
Wilkes, Mahlon M.
中科院分区：
文献类型：
--
作者：
Orange, Jordan S.;Grossman, William J.;Wilkes, Mahlon M.
与低丙种球蛋白血症相关的原发性免疫缺陷病（PIDD）通常采用免疫球蛋白替代疗法治疗。当作为静脉注射免疫球蛋白（IVIG）给药时，IgG谷值发生在下一次替代剂量之前。虽然经常测量，但最大限度地降低感染风险所需的IgG谷水平尚未确定。为了解决这一问题，通过荟萃分析对所有评价接受IVIG治疗的低丙种球蛋白血症PIDD患者的IgG谷值和肺炎发生率的研究进行了定量分析。纳入了17项研究，共676例患者，随访2,127患者年。IgG谷值每增加100 mg/dL，肺炎发生率下降27%（发生率比，0.726; 95%置信区间，0.658-0.801）。IgG谷浓度维持在500 mg/dL（0.113例/患者-年）时的肺炎发生率是1000 mg/dL（0.023例/患者-年）时的5倍。这项荟萃分析提供的证据表明，通过将IgG谷浓度升高至至少1000 mg/dL，可以逐渐降低肺炎风险。(C)2010年爱思唯尔公司All rights reserved.
Primary immunodeficiency disease (PIDD) associated with hypogammaglobulinemia is typically treated with immunoglobulin replacement therapy. When administered as intravenous immunoglobulin (IVIG), an IgG trough occurs prior to the next replacement dose. While frequently measured, IgG trough levels required to minimize infection risk are not established. To address this question, all available studies evaluating trough IgG and pneumonia incidence in PIDD patients with hypogammaglobulinemia receiving IVIG were quantitatively combined by meta-analysis. Seventeen studies with 676 total patients and 2,127 patient-years of follow-up were included. Pneumonia incidence declined by 27% with each 100 mg/dL increment in trough IgG (incidence rate ratio, 0.726; 95% confidence interval, 0.658-0.801). Pneumonia incidence with maintenance of 500 mg/dL IgG trough levels (0.113 cases per patient-year) was 5-fold that with 1000 mg/dL (0.023 cases per patient-year). This meta-analysis provides evidence that pneumonia risk can be progressively reduced by higher trough IgG levels up to at least 1000 mg/dL. (C) 2010 Elsevier Inc. All rights reserved.