Martinot Martin, Oswald Laetitia, Parisi Elisabeth, Etienne Elodie, Argy Nicolas, Grawey Isabelle, De Briel Dominique, Zadeh Mahsa Mohseni, Federici Laure, Blaison Gilles, Koebel Christelle, Jaulhac Benoit, Hansmann Yves, Christmann Daniel
Internal Medicine and Rheumatology Department, Hôpital Civil de Colmar, 39 avenue de la Liberté, 68024 Colmar Cédex, France.
Infectious and Tropical Diseases Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Int J Infect Dis. 2014 Feb;19:79-84. doi: 10.1016/j.ijid.2013.10.020. Epub 2013 Dec 8.
Immunoglobulin (Ig) deficiency is a well-known risk factor for Streptococcus pneumoniae or Haemophilus influenzae infections and noteworthy invasive diseases. However, the proportion of these deficiencies in cases of invasive disease is unknown. The objective of this study was to evaluate the rate of Ig deficiency in cases of invasive disease.
A prospective study was conducted from January 2008 to October 2010 in two French hospitals. Measurement of Ig levels was carried out in patients hospitalized for invasive diseases.
A total of 119 patients were enrolled in the study, with nine cases of H. influenzae and 110 cases of S. pneumoniae invasive disease. There were 18 cases of meningitis, 79 of invasive pneumonia, and 22 other invasive diseases. Forty-five patients (37.8%) had an Ig abnormality, 37 of whom had an Ig deficiency (20 IgG <6g/l, four isolated IgA <0.7g/l, and 13 isolated IgM <0.5g/l), while eight had an elevated monoclonal paraprotein. Nineteen of these 45 patients had a clearly defined Ig abnormality, with five primary deficiencies (three common variable immunodeficiencies and two complete IgA deficiencies) and 14 secondary deficiencies, mainly lymphoproliferative disorders. All these deficiencies were either not known or not substituted.
Humoral deficiency is frequent in patients with S. pneumoniae or H. influenzae invasive disease and Ig dosage should be proposed systematically after such infections.
免疫球蛋白（Ig）缺乏是肺炎链球菌或流感嗜血杆菌感染及值得关注的侵袭性疾病的一个众所周知的危险因素。然而，这些缺乏在侵袭性疾病病例中的比例尚不清楚。本研究的目的是评估侵袭性疾病病例中Ig缺乏的发生率。
2008年1月至2010年10月在法国两家医院进行了一项前瞻性研究。对因侵袭性疾病住院的患者进行Ig水平测定。
共有119例患者纳入研究，其中9例为流感嗜血杆菌侵袭性疾病，110例为肺炎链球菌侵袭性疾病。有18例脑膜炎、79例侵袭性肺炎和22例其他侵袭性疾病。45例患者（37.8%）存在Ig异常，其中37例存在Ig缺乏（20例IgG<6g/l，4例孤立性IgA<0.7g/l，13例孤立性IgM<0.5g/l），8例单克隆副蛋白升高。这45例患者中有19例存在明确的Ig异常，其中5例为原发性缺乏（3例常见变异型免疫缺陷和2例完全性IgA缺乏），14例为继发性缺乏，主要是淋巴增殖性疾病。所有这些缺乏均未被认识或未得到替代治疗。
肺炎链球菌或流感嗜血杆菌侵袭性疾病患者中体液免疫缺乏很常见，此类感染后应系统地进行Ig定量检测。
