Yip Natalie H, Lederer David J, Kawut Steven M, Wilt Jessie S, D'Ovidio Frank, Wang Yuanjia, Dwyer Edward, Sonett Joshua R, Arcasoy Selim M
Department of Medicine ad Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Am J Respir Crit Care Med. 2006 Apr 15;173(8):917-21. doi: 10.1164/rccm.200510-1609OC. Epub 2006 Jan 6.
The determinants of immunoglobulin G (IgG) level and the risk of hypogammaglobulinemia (HGG) in patients with severe lung disease before and after lung transplantation are unknown.
We aimed to identify predictors of low IgG levels before and after lung transplantation.
We performed a retrospective cohort study of 40 consecutive lung transplant recipients at our center. Total IgG levels were measured before and serially after transplantation. Mild HGG was defined as IgG levels from 400-699 mg/dl; severe HGG was defined as IgG levels<400 mg/dl.
Before transplantation, six (15%) patients had mild HGG, and none had severe HGG. Patients with chronic obstructive pulmonary disease had lower IgG levels compared with patients with other diseases (independent of corticosteroid use and age; p=0.001) and an increased risk of mild HGG (p=0.005). The cumulative incidences of mild and severe HGG significantly increased after transplantation (58 and 15%, respectively, both p<0.04 compared with pretransplant prevalences). Lower pretransplant IgG level and treatment with mycophenolate mofetil were associated with lower IgG levels after transplantation (both p<0.05). Only lower pretransplant IgG levels were significantly associated with an increased risk of severe HGG after transplantation (p=0.02).
Mild HGG is common in patients with severe chronic obstructive pulmonary disease, and the incidences of mild and severe HGG increase significantly early after lung transplantation. Baseline IgG levels and treatment with mycophenolate mofetil affect post-transplant IgG levels.
严重肺部疾病患者在肺移植前后免疫球蛋白G（IgG）水平的决定因素以及低丙种球蛋白血症（HGG）的风险尚不清楚。
我们旨在确定肺移植前后低IgG水平的预测因素。
我们对本中心40例连续的肺移植受者进行了一项回顾性队列研究。在移植前和移植后连续测量总IgG水平。轻度HGG定义为IgG水平为400 - 699mg/dl；重度HGG定义为IgG水平<400mg/dl。
移植前，6例（15%）患者有轻度HGG，无重度HGG患者。与其他疾病患者相比，慢性阻塞性肺疾病患者的IgG水平较低（与皮质类固醇使用和年龄无关；p = 0.001），且轻度HGG风险增加（p = 0.005）。移植后轻度和重度HGG的累积发生率显著增加（分别为58%和15%，与移植前患病率相比，两者p<0.04）。移植前IgG水平较低和使用霉酚酸酯治疗与移植后较低的IgG水平相关（两者p<0.05）。只有移植前较低的IgG水平与移植后重度HGG风险增加显著相关（p = 0.02）。
轻度HGG在严重慢性阻塞性肺疾病患者中常见，且轻度和重度HGG的发生率在肺移植后早期显著增加。基线IgG水平和霉酚酸酯治疗会影响移植后的IgG水平。
