Průcha M, Zazula R, Herold I, Dostál M, Hyánek T, Bellingan G
Department of Clinical Biochemistry, Hematology and Immunology, Na Homolce Hospital, Prague, Czech Republic.
Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic;
Prague Med Rep. 2013;114(4):246-57. doi: 10.14712/23362936.2014.14.
In this retrospective study we assessed the frequency of hypogammaglobulinemia in 708 patients with SIRS, severe sepsis and septic shock. We evaluated the relationship between hypogammaglobulinemia IgG, IgM and 28 day mortality. Total of 708 patients and 1,513 samples were analyzed. In the three subgroups we investigated, patients met the criteria of SIRS, severe sepsis and septic shock. IgG hypogammaglobulinemia was demonstrated in 114 patients with severe sepsis (25.2%), 11 septic shock patients (24.4%), and in 29 SIRS patients (13.9%). IgM hypogammaglobulinemia was documented in 55 patients with severe sepsis (12.2%), 6 septic shock patients (13.3%), and in 17 SIRS patients (8.1%). Mortality of patients with severe sepsis and normal IgG levels was significantly lower (111 patients; 32.8%) compared with those with IgG hypogammaglobulinemia (49 patients; 43.0%; p=0.001). Mortality of patients with septic shock and IgG hypogammaglobulinemia (n=5) was significantly higher compared with those with normal IgG levels (45.5% vs. 38.2%; p=0.001). Mortality of patients with severe sepsis and IgM hypogammaglobulinemia did not differ from that of patients with normal IgM levels (37.0 vs. 41.8%). Mortality of patients with septic shock and IgM hypogammaglobulinemia was significantly higher compared with those with normal IgM levels (50% vs. 38.5%; p=0.0001). This study documented relatively high incidence of hypogammaglobulinemia IgG and IgM in patients with severe sepsis, septic shock and SIRS respectively. The presence of IgG hypogammaglobulinemia in patients with severe sepsis is independent factor of mortality.
在这项回顾性研究中，我们评估了708例全身炎症反应综合征（SIRS）、严重脓毒症和脓毒性休克患者低丙种球蛋白血症的发生率。我们评估了低丙种球蛋白血症IgG、IgM与28天死亡率之间的关系。共分析了708例患者和1513份样本。在我们研究的三个亚组中，患者符合SIRS、严重脓毒症和脓毒性休克的标准。114例严重脓毒症患者（25.2%）、11例脓毒性休克患者（24.4%）和29例SIRS患者（13.9%）出现IgG低丙种球蛋白血症。55例严重脓毒症患者（12.2%）、6例脓毒性休克患者（13.3%）和17例SIRS患者（8.1%）记录有IgM低丙种球蛋白血症。严重脓毒症且IgG水平正常的患者死亡率（111例；32.8%）显著低于IgG低丙种球蛋白血症患者（49例；43.0%；p=0.001）。脓毒性休克且IgG低丙种球蛋白血症患者（n=5）的死亡率显著高于IgG水平正常的患者（45.5%对38.2%；p=0.001）。严重脓毒症且IgM低丙种球蛋白血症患者的死亡率与IgM水平正常的患者无差异（37.0对41.8%）。脓毒性休克且IgM低丙种球蛋白血症患者的死亡率显著高于IgM水平正常的患者（50%对38.5%；p=0.0001）。本研究记录了严重脓毒症、脓毒性休克和SIRS患者中IgG和IgM低丙种球蛋白血症的发生率相对较高。严重脓毒症患者中IgG低丙种球蛋白血症的存在是死亡率的独立因素。
