Konstantinopoulos Panagiotis A, Dezube Bruce J, Pantanowitz Liron, Horowitz Gary L, Beckwith Bruce A
Division of Hematology--Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Am J Clin Pathol. 2007 Oct;128(4):596-603. doi: 10.1309/QWTQFGA9FXN02YME.
We studied the prevalence and nature of immunoglobulin abnormalities in HIV-1-infected patients in the era of highly active antiretroviral therapy. Protein electrophoreses (PEP) were performed on and quantitative immunoglobulin levels obtained in samples from 320 consecutive HIV-1-infected patients. Samples with possible PEP abnormalities underwent immunofixation. The PEP pattern was normal in 83.8% of samples, 8.1% had subtle oligoclonal banding, and 4.4% had a low-concentration (<5% of total protein) monoclonal band. Hypogammaglobulinemia and polyclonal hypergammaglobulinemia accounted for 1.9% each. In multivariate analysis, younger age (odds ratio [OR], 1.06 with each decreasing year of life; 95% confidence interval [CI], 1.02-1.11; P = .016), female sex (OR, 2.4; 95% CI, 1.13-5.11; P = .02), viral load (OR, 1.50 with each increasing logarithmic viral load of 1.0; 95% CI, 1.14-1.98; P = .004), and CD4 cell count (> or =350 vs <350/microL [0.35 x 10(9)/L]) (OR, 2.71; 95% CI, 1.09-6.75; P = .032) were associated with monoclonal or oligoclonal banding. These results suggest that younger HIV-1-infected patients with a more robust immune system (higher CD4 cell count), which is stimulated by uncontrolled viremia, are most likely to have an augmented B-cell response to HIV infection. One manifestation of this B-cell response is low-concentration monoclonal banding in 4.4% of the patients studied.
我们研究了高效抗逆转录病毒治疗时代HIV-1感染患者免疫球蛋白异常的患病率及性质。对320例连续的HIV-1感染患者的样本进行了蛋白电泳（PEP）并测定了定量免疫球蛋白水平。对可能存在PEP异常的样本进行免疫固定。83.8%的样本PEP模式正常，8.1%有细微的寡克隆条带，4.4%有低浓度（<总蛋白的5%）单克隆条带。低丙种球蛋白血症和多克隆高丙种球蛋白血症各占1.9%。多因素分析显示，年龄较小（比值比[OR]，每年轻1岁为1.06；95%置信区间[CI]，1.02 - 1.11；P = 0.016）、女性（OR，2.4；95% CI，1.13 - 5.11；P = 0.02）、病毒载量（OR，每增加1.0对数病毒载量为1.50；95% CI，1.14 - 1.98；P = 0.004）以及CD4细胞计数（≥350 vs <350/μL [0.35×10⁹/L]）（OR，2.71；95% CI，1.09 - 6.75；P = 0.032）与单克隆或寡克隆条带相关。这些结果表明，免疫系统较强（CD4细胞计数较高）的年轻HIV-1感染患者，受到未控制的病毒血症刺激，最有可能对HIV感染有增强的B细胞反应。这种B细胞反应的一种表现是在4.4%的研究患者中出现低浓度单克隆条带。
