Pettit S J, Bourne H, Spickett G P
Department of Immunology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK.
J Clin Pathol. 2002 Aug;55(8):577-80. doi: 10.1136/jcp.55.8.577.
Primary antibody deficiency disorders are a heterogeneous group of disorders, which are treated by regular infusions of immunoglobulin. Despite replacement treatment, patients remain susceptible to infection. Effective management of infections is necessary to prevent the complications of chronic infection.
This retrospective survey of clinical practice examined the management of infections in patients who receive immunoglobulin replacement for immune deficiency.
Patients who received immunoglobulin replacement treatment in Newcastle during the year 2000 were identified. Medical records were reviewed. Basic clinical information and details of immunoglobulin replacement treatment were recorded. Episodes of infection were defined by documented symptoms, signs, or investigation results, and by the prescription of an antibiotic course. Details of episodes of infection and antimicrobial treatment were recorded.
Thirty seven patients received immunoglobulin replacement during 2000. There were 101 episodes of infection. There was no correlation between the frequency of infection and the IgG trough value. Respiratory tract infections were most common (71 of 101). Where documented, 80% of infections were associated with clinical signs, 21% with pyrexia, and 64% with a raised C reactive protein value. Microbiological culture was performed in 30% of infections. Antimicrobial treatment was instituted along "best guess" lines in 99 of 101 episodes of infection.
Management of respiratory tract infections represents the largest problem in antibody deficient patients. Greater use of microbiological culture might allow more effective prescription of antimicrobial treatment. The generation of treatment guidelines and improved communication with general practitioners could improve the management of all episodes of infection.
原发性抗体缺陷病是一组异质性疾病，通过定期输注免疫球蛋白进行治疗。尽管进行了替代治疗，但患者仍易感染。有效管理感染对于预防慢性感染的并发症很有必要。
这项临床实践回顾性调查研究了接受免疫球蛋白替代治疗免疫缺陷患者的感染管理情况。
确定了2000年在纽卡斯尔接受免疫球蛋白替代治疗的患者。查阅了病历。记录了基本临床信息和免疫球蛋白替代治疗的详细情况。感染发作通过记录的症状、体征或检查结果以及抗生素疗程的处方来定义。记录了感染发作及抗菌治疗的详细情况。
2000年有37例患者接受了免疫球蛋白替代治疗。共发生101次感染发作。感染频率与免疫球蛋白G谷值之间无相关性。呼吸道感染最为常见（101次中有71次）。有记录显示，80%的感染伴有临床体征，21%伴有发热，64%伴有C反应蛋白值升高。30%的感染进行了微生物培养。101次感染发作中有99次根据“最佳猜测”进行了抗菌治疗。
呼吸道感染的管理是抗体缺陷患者面临的最大问题。更多地使用微生物培养可能会使抗菌治疗的处方更有效。制定治疗指南并改善与全科医生的沟通可以改善所有感染发作的管理。
