严重大流行性 2009 年甲型流感（H1N1）病毒感染与免疫球蛋白 G（2）亚类缺乏症的相关性。

Association between severe pandemic 2009 influenza A (H1N1) virus infection and immunoglobulin G(2) subclass deficiency.

机构信息

Infectious Diseases Department, Austin Health, University of Melbourne, Australia.

出版信息

Clin Infect Dis. 2010 Mar 1;50(5):672-8. doi: 10.1086/650462.

DOI:10.1086/650462

PMID:20121412

Abstract

BACKGROUND

. Severe pandemic 2009 influenza A virus (H1N1) infection is associated with risk factors that include pregnancy, obesity, and immunosuppression. After identification of immunoglobulin G(2) (IgG(2)) deficiency in 1 severe case, we assessed IgG subclass levels in a cohort of patients with H1N1 infection.

METHODS

Patient features, including levels of serum IgG and IgG subclasses, were assessed in patients with acute severe H1N1 infection (defined as infection requiring respiratory support in an intensive care unit), patients with moderate H1N1 infection (defined as inpatients not hospitalized in an intensive care unit), and a random sample of healthy pregnant women.

RESULTS

Among the 39 patients with H1N1 infection (19 with severe infection, 7 of whom were pregnant; 20 with moderate infection, 2 of whom were pregnant), hypoabuminemia (P < .001), anemia (P < .001), and low levels of total IgG (P= .01), IgG(1) (P= .022), and IgG(2) (15 of 19 vs 5 of 20; P= .001; mean value +/- standard deviation [SD], 1.8 +/- 1.7 g/L vs 3.4 +/- 1.4 g/L; P= .003) were all statistically significantly associated with severe H1N1 infection, but only hypoalbuminemia (P= .02) and low mean IgG(2) levels (P= .043) remained significant after multivariate analysis. Follow-up of 15 (79%) surviving IgG(2)-deficient patients at a mean (+/- SD) of 90 +/- 23 days (R, 38-126) after the initial acute specimen was obtained found that hypoalbuminemia had resolved in most cases, but 11 (73%) of 15 patients remained IgG(2) deficient. Among 17 healthy pregnant control subjects, mildly low IgG(1) and/or IgG(2) levels were noted in 10, but pregnant patients with H1N1 infection had significantly lower levels of IgG(2) (P= .001).

CONCLUSIONS

Severe H1N1 infection is associated with IgG(2) deficiency, which appears to persist in a majority of patients. Pregnancy-related reductions in IgG(2) level may explain the increased severity of H1N1 infection in some but not all pregnant patients. The role of IgG(2) deficiency in the pathogenesis of H1N1 infection requires further investigation, because it may have therapeutic implications.

摘要

背景

严重的大流行性 2009 年甲型流感病毒（H1N1）感染与包括妊娠、肥胖和免疫抑制在内的危险因素有关。在 1 例重症病例中发现免疫球蛋白 G（2）（IgG（2））缺陷后，我们评估了甲型 H1N1 感染患者的 IgG 亚类水平。

方法

评估了急性严重甲型 H1N1 感染（定义为需要在重症监护病房接受呼吸支持的感染）患者、中度甲型 H1N1 感染（定义为未住院于重症监护病房的住院患者）患者以及随机抽取的健康孕妇的患者特征，包括血清 IgG 和 IgG 亚类水平。

结果

在 39 例甲型 H1N1 感染患者（19 例严重感染，其中 7 例妊娠；20 例中度感染，其中 2 例妊娠）中，低白蛋白血症（P <.001）、贫血（P <.001）和总 IgG（P=.01）、IgG（1）（P=.022）和 IgG（2）（19 例中有 15 例 vs 20 例中有 2 例；P=.001；均数 +/- 标准差 [SD]，1.8 +/- 1.7 g/L vs 3.4 +/- 1.4 g/L；P=.003）水平低与严重甲型 H1N1 感染均具有统计学显著相关性，但在多变量分析中仅低白蛋白血症（P=.02）和低平均 IgG（2）水平（P=.043）仍具有显著意义。在获得初始急性标本后平均（ +/- SD）90 +/- 23 天（R，38-126）对 15 例（79%）存活的 IgG（2）缺陷患者进行随访发现，大多数情况下低白蛋白血症已得到纠正，但 15 例中有 11 例（73%）仍存在 IgG（2）缺陷。在 17 例健康妊娠对照中，有 10 例 IgG（1）和/或 IgG（2）水平轻度降低，但甲型 H1N1 感染孕妇的 IgG（2）水平明显降低（P=.001）。