IMMUNOGLOBULIN SUBCLASSES AND PROPHYLACTIC USE OF IMMUNOGLOBULIN IN IMMUNOGLOBULIN-G SUBCLASS DEFICIENCY
IMMUNOGLOBULIN SUBCLASSES AND PROPHYLACTIC USE OF IMMUNOGLOBULIN IN IMMUNOGLOBULIN-G SUBCLASS DEFICIENCY
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DOI：
10.1002/1097-0142(19910915)68:6
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发表时间：
1991-09-15
期刊：
影响因子：
6.2
通讯作者：
ENSKOG, A
中科院分区：
文献类型：
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作者：
SODERSTROM, T;SODERSTROM, R;ENSKOG, A
一种或几种免疫球蛋白G（IgG）亚类的持续低血清水平可在高比例的成人患者中发现，这些患者对感染的易感性增加。很难想象低亚类水平本身是这种易感性的原因，因为健康献血者的血清中完全没有某些亚类。这种明显的差异可以部分解释为观察到大多数亚类缺陷患者在T细胞和B细胞相互作用和功能方面存在潜在的畸变，这可能会损害他们弥补即使是轻微缺陷的能力。对43例成人IgG亚类缺乏症患者进行了预防性IG替代治疗的前瞻性盲交叉研究。患者随机接受1年肌肉注射IG 25 mg/kg/wk或1年生理盐水注射治疗。观察到预防性IG治疗的显著保护作用，感染天数大大减少。此外，IG治疗1年后，几项免疫学参数发生了变化。随后，19例患者被纳入一项使用50 mg/kg/wk IG的开放性研究。治疗6个月后，观察到对感染的显著保护，每月感染天数减少6.2天。预防性IG的这种显著作用表明，在IgG亚类缺陷患者中观察到的IG畸变导致了他们对感染的易感性。25 mg/kg/wk的作用远不如50 mg/kg/wk显著，即使在较高剂量治疗期间也未达到正常血清IgG亚类水平。然而，皮下或静脉注射较大剂量的IG似乎可以实现更有效的治疗。
Persistent low serum levels of one or several immunoglobulin G (IgG) subclasses can be found in a high proportion of adult patients with increased susceptibility to infections. It is hard to envision that the low subclass level in itself is responsible for this susceptibility because healthy blood donors have been described who are completely devoid of certain subclasses in serum. This apparent discrepancy may be partly explained by the observation that most subclass-deficient patients have underlying aberrations in T-cell and B-cell interaction and function that may impair their capacity to compensate for even minor deficiencies. A prospective blind crossover study of the effect of prophylactic Ig substitution therapy was done in 43 adult patients with IgG subclass deficiency. The patients were randomized to receive 1 year of therapy with intramuscular Ig 25 mg/kg/wk or 1 year of saline injections. A significant protective effect of the prophylactic Ig therapy was seen with a great reduction in the number of days of infection. In addition, several immunologic parameters were altered after 1 year of Ig therapy. Nineteen of the patients later were included in an open study using 50 mg/kg/wk of Ig. After 6 months of treatment, significant protection against infection was observed, with a reduction of 6.2 days in the number of days per month with infection. This marked effect of prophylactic Ig suggests that the Ig aberrations seen in IgG subclass-deficient patients contributed to their susceptibility to infection. The effect of 25 mg/kg/wk was much less pronounced than that of 50 mg/kg/wk, and normal serum IgG subclass levels were not achieved even during the higher-dose therapy. However, it seems likely that subcutaneous or intravenous administration of larger doses of Ig would allow for more efficient therapy.