Association between IgG2 and IgG3 subclass responses to toxin A and recurrent Clostridium difficile-associated disease.
Association between IgG2 and IgG3 subclass responses to toxin A and recurrent Clostridium difficile-associated disease.
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IgG2 和 IgG3 亚类对毒素 A 的反应与复发性艰难梭菌相关疾病之间的关联。
DOI：
10.1016/j.cgh.2007.02.025
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
Kelly,CiaranP
中科院分区：
文献类型：
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作者：
Katchar,Kianoosh;Taylor,ClaribelP;Tummala,Sanjeev;Chen,Xinhua;Sheikh,Javed;Kelly,CiaranP
背景与目的对毒素a产生显著血清免疫球蛋白（Ig）G反应的个体可预防复发性艰难梭菌相关疾病（CDAD）。我们研究了体液免疫缺陷和/或特异性IgG亚类反应是否与复发性CDAD相关。方法比较13例复发性CDAD患者的临床特征和体液免疫反应，并与13例对照患者进行对比。我们测量了破伤风和白喉类毒素血清IgG滴度，以及毒素A和毒素b特异性血清IgG、IgA和IgG亚类浓度。结果单一和复发CDAD受试者在年龄、性别、种族或其他潜在的混杂变量方面没有差异。复发性CDAD患者的总腹泻持续时间更长（中位数，62天vs 17天；P = 0.005）。两组破伤风和白喉类毒素IgG滴度、总IgG和IgG亚类水平相似。复发性CDAD患者的总IgA略低（204 vs 254 mg/dL; P = 0.05）。两组患者IgA、IgG、IgG1、IgG4抗毒素A、抗毒素B水平相似。而复发组IgG2和IgG3抗毒素A水平明显降低（P = 0.01和P = 0.01）。001年,分别)。结论复发性CDAD患者未表现出广泛的体液免疫缺陷或IgG亚类缺陷。低血清IgG抗毒素A浓度反映了选择性降低的IgG2和IgG3亚类反应。测量特异性IgG2/3抗毒素A可能有助于选择使用药物治疗的患者，以防止复发性CDAD。
Background & AimsIndividuals who mount a significant serum immunoglobulin (Ig)G response to toxin A are protected against recurrent Clostridium difficile–associated disease (CDAD). We investigated whether humoral immune deficiencies and/or specific IgG subclass responses are associated with recurrent CDAD.MethodsWe compared the clinical characteristics and humoral immune responses of 13 patients with recurrent CDAD with 13 matched controls with a single CDAD episode. We measured the serum IgG titers to tetanus and diphtheria toxoids, as well as total and toxin A– and toxin B–specific serum IgG, IgA, and IgG subclass concentrations.ResultsThere were no differences between the single and recurrent CDAD subjects in terms of age, sex, ethnicity, or other potential confounding variables. The total duration of diarrhea in patients with recurrent CDAD was greater (median, 62 vs 17 days; P = .005). IgG titers to tetanus and diphtheria toxoids, total IgG, and IgG subclass levels were similar in both groups. The total IgA was somewhat lower in those with recurrent CDAD (204 vs 254 mg/dL; P = .05). IgA, IgG, IgG1, and IgG4 anti–toxin A and anti–toxin B levels were similar in both groups. However, IgG2 and IgG3 anti–toxin A levels were significantly lower in the recurrent group (P = .01 and .001, respectively).ConclusionsSubjects with recurrent CDAD did not show evidence of widespread humoral immune deficiency or of IgG subclass deficiency. Their low serum IgG anti–toxin A concentrations reflected selectively reduced IgG2 and IgG3 subclass responses. Measurement of specific IgG2/3 anti–toxin A may be useful in selecting patients for treatment with agents to prevent recurrent CDAD.