Norrby-Teglund Anna, Ihendyane Nahla, Darenberg Jessica
Center for Infectious Medicine, Department of Medicine, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden.
Scand J Infect Dis. 2003;35(9):683-9. doi: 10.1080/00365540310015944.
Immunotherapy targeted against microbial toxins and host mediators has been studied in many preclinical investigations and clinical trials of sepsis during the past 20 y. Intravenous immunoglobulin, including both monoclonal and polyclonal antibodies, represents one such immunotherapeutic strategy. Mononclonal antibodies directed against endotoxin or tumour necrosis factor-alpha have been tested extensively in clinical trials, but have so far failed to reveal a significant effect on mortality rates. Several studies have assessed the efficacy of polyclonal intravenous immunoglobulin (IVIG) in sepsis, with varying results. Although there are no conclusive data available to date to support the use of IVIG therapy in all sepsis cases, there are strong indications that certain defined septic subgroups, such as streptococcal toxic shock syndrome caused by group A streptococcus, will benefit from its use. This review briefly summarizes the clinical trials on IVIG therapy in sepsis, and describes in more detail the mechanistic actions of IVIG and the clinical data that support the use of IVIG as adjunctive therapy in severe invasive group A streptococcal infections.
在过去20年中，针对微生物毒素和宿主介质的免疫疗法已在许多脓毒症的临床前研究和临床试验中得到研究。静脉注射免疫球蛋白，包括单克隆抗体和多克隆抗体，代表了一种这样的免疫治疗策略。针对内毒素或肿瘤坏死因子-α的单克隆抗体已在临床试验中进行了广泛测试，但迄今为止尚未显示出对死亡率有显著影响。多项研究评估了多克隆静脉注射免疫球蛋白（IVIG）在脓毒症中的疗效，结果各不相同。尽管目前尚无确凿数据支持在所有脓毒症病例中使用IVIG治疗，但有强有力的迹象表明，某些特定的脓毒症亚组，如由A组链球菌引起的链球菌中毒性休克综合征，将从其使用中获益。本综述简要总结了关于IVIG治疗脓毒症的临床试验，并更详细地描述了IVIG的作用机制以及支持将IVIG用作严重侵袭性A组链球菌感染辅助治疗的临床数据。
