Pathology Department, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2009;64(12):1155-60. doi: 10.1590/S1807-59322009001200004.
Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood.
The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis.
The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36+/-17 years) and comprised predominantly of females (n=11).
Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm(3), p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05).
We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.
普通变异性免疫缺陷的特征是抗体产生缺陷和反复肺部感染。静脉注射免疫球蛋白是首选治疗方法，但静脉注射免疫球蛋白对肺部防御机制的影响知之甚少。
本研究旨在验证静脉注射免疫球蛋白对伴有支气管扩张症的普通变异性免疫缺陷患者的痰液物理性质和气道炎症改变的影响。
本研究分析了 7 例伴有支气管扩张症的普通变异性免疫缺陷患者的痰液物理性质、呼出气一氧化氮（NO）、痰液中的炎症细胞和免疫球蛋白（IG）滴度，这些患者在接受静脉注射免疫球蛋白治疗前和治疗后 15 天进行了痰液检查。还对 6 例无痰液的伴有支气管扩张症的普通变异性免疫缺陷患者进行了比较，以比较基础 IgG 水平和血常规。这 13 名患者均为年轻人（年龄=36+/-17 岁），女性居多（n=11）。
有分泌物的患者 IgG 和 IgM 水平明显降低。静脉注射免疫球蛋白与呼出气 NO（54.7 vs. 40.1 ppb，p<0.05）、痰液炎症细胞计数（28.7 vs. 14.6 个/mm(3)，p<0.05）显著降低以及咳嗽时呼吸黏液输送能力显著增加（42.5 vs. 65.0 mm，p < 0.05）相关。
我们得出结论，在普通变异性免疫缺陷患者中给予免疫球蛋白治疗可显著改善气道炎症指标，并改善咳嗽时呼吸黏液的输送能力。
