Sheridan J F, Tutschka P J, Sedmak D D, Copelan E A
Department of Internal Medicine, Ohio State University College of Medicine, Columbus 43210.
Blood. 1990 Apr 1;75(7):1583-6.
Serum immunoglobulin (Ig) G subclass levels were measured in a radial immunodiffusion assay in 25 leukemic patients before and after allogenic bone marrow transplantation. All patients received a conditioning regimen of busulfan and cyclophosphamide followed by infusion of marrow from an HLA-identical sibling. Intravenous infusions of a commercial Ig preparation were administered every 2 weeks until day 120 posttransplant. Nine patients developed pneumococcal infections at 6 months or greater posttransplant. Infection was associated with low levels or the absence of detectable serum IgG2 and IgG4. At the time of infection, 4 of 7 patients evaluated had undetectable IgG2, while 5 of 7 had undetectable levels of IgG4. After infection, none of the 8 patients evaluated had detectable levels of IgG2, and only 2 of 8 had detectable levels of IgG4. In contrast, all 16 patients without pneumococcal infection had IgG2 levels of 102 mg/dL or greater, and IgG4 levels of 20 mg/dL or greater. It appears that IgG2 and IgG4 subclass deficiencies after allogenic bone marrow transplantation contribute to susceptibility to pneumococcal infection. After pneumococcal infection, IgG2 and IgG4 levels remain low for a prolonged period and patients remain susceptible to infection by encapsulated organisms.
采用放射免疫扩散法对25例白血病患者在异基因骨髓移植前后的血清免疫球蛋白（Ig）G亚类水平进行了检测。所有患者均接受了白消安和环磷酰胺的预处理方案，随后输注来自HLA匹配同胞的骨髓。在移植后第120天前，每2周静脉输注一次市售Ig制剂。9例患者在移植后6个月或更长时间发生了肺炎球菌感染。感染与血清IgG2和IgG4水平低或检测不到有关。在感染时，接受评估的7例患者中有4例IgG2检测不到，而7例中有5例IgG4水平检测不到。感染后，接受评估的8例患者中无一例IgG2水平可检测到，8例中只有2例IgG4水平可检测到。相比之下，所有16例未发生肺炎球菌感染的患者IgG2水平均在102mg/dL或以上，IgG4水平在20mg/dL或以上。异基因骨髓移植后IgG2和IgG4亚类缺陷似乎导致了对肺炎球菌感染的易感性。肺炎球菌感染后，IgG2和IgG4水平长时间保持较低，患者仍易受包膜菌感染。
