Nottingham University Hospitals NHS Trust-Immunology, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH, UK.
Rheumatology (Oxford). 2010 Jun;49(6):1040-8. doi: 10.1093/rheumatology/keq021. Epub 2010 Feb 23.
For many years, non-steroidal anti-inflammatory agents, steroids and immunosuppressive drugs have been the mainstay of treatment for rheumatological disorders. Over the last few years, the emergence of biologic treatments has dramatically changed the management of numerous rheumatological diseases. However, immunoglobulin treatment has been used for decades and its use has still not been superseded in certain rheumatological diseases. In fact, despite the introduction of newer immunomodulatory drugs, there has been an ever-increasing number of clinical indications for which intravenous immunoglobulin (IVIG) has been tried. Immunoglobulins are plasma proteins secreted by plasma cells, forming a major component of the adaptive immune system. IVIG is a blood product prepared from plasma, each batch prepared from a pool of 10,000-20,000 donations. Multiple purification steps during the manufacturing process aim to eliminate all known transmissible pathogens, but cannot completely exclude the risk from unknown pathogens. It should be noted that there has been the transmission of hepatitis C in one batch of immunoglobulin, reported in 1994, resulting in more than 200 patients in the USA and Europe being affected. Nevertheless, IVIG remains relatively safe compared with other immunosuppressive drugs. Headaches and fatigue are common side effects but fortunately the more severe problems such as aseptic meningitis, venous thromboembolism and acute renal failure remain rare. High-dose immunoglobulin when administered i.v. has immunomodulatory properties. The precise mechanism of action of IVIG is complex and not yet fully understood.
多年来，非甾体抗炎药、类固醇和免疫抑制剂一直是治疗风湿性疾病的主要方法。在过去的几年中，生物治疗的出现极大地改变了许多风湿性疾病的治疗方法。然而，免疫球蛋白的治疗已经使用了几十年，其在某些风湿性疾病中的应用仍然没有被取代。事实上，尽管新型免疫调节剂的出现，静脉注射免疫球蛋白（IVIG）的临床应用指征越来越多。免疫球蛋白是浆细胞分泌的血浆蛋白，构成适应性免疫系统的主要成分。IVIG 是一种从血浆中制备的血液制品，每批制品由 10000-20000 份捐赠物的混合物制成。在生产过程中的多个纯化步骤旨在消除所有已知的可传播病原体，但不能完全排除未知病原体的风险。值得注意的是，1994 年报告了一批免疫球蛋白中丙型肝炎的传播，导致美国和欧洲的 200 多名患者受到影响。然而，与其他免疫抑制剂相比，IVIG 仍然相对安全。头痛和疲劳是常见的副作用，但幸运的是，更严重的问题，如无菌性脑膜炎、静脉血栓栓塞和急性肾衰竭仍然很少见。高剂量免疫球蛋白静脉注射具有免疫调节作用。IVIG 的作用机制复杂，尚未完全阐明。
