Zemlin Annalise E, Ipp Hayley, Maleka Sechaba, Erasmus Rajiv T
Division of Chemical Pathology, Department of Pathology, University of Stellenbosch and NHLS, Tygerberg Hospital, South Africa
Division of Haematology, Department of Pathology, University of Stellenbosch and NHLS, Tygerberg Hospital, South Africa.
Ann Clin Biochem. 2015 May;52(Pt 3):346-51. doi: 10.1177/0004563214565824. Epub 2014 Dec 8.
B lymphocyte stimulation is described in human immunodeficiency virus (HIV) infection and results in ongoing immunoglobulin production with abnormal serum protein electrophoresis patterns. We hypothesized that serum protein electrophoresis patterns would be abnormal in untreated HIV subjects and correlate with markers of disease severity.
Serum protein electrophoresis was performed on 70 HIV-positive, clinically well treatment-naïve subjects and 42 HIV-negative controls and correlated with markers of disease severity, namely CD4+ counts, viral loads, IgG and albumin.
The mean age for both groups was 33 years, and female-to-male ratios were 4:1. All were of Black ethnicity. Mean CD4 counts ± SD for HIV group and controls were 419.5 ± 218.6 and 960.4 ± 378.5 cells/mm(3), respectively. Of the HIV-infected group, 44% showed polyclonal hypergammaglobulinaemia versus 10% of controls (P < 0.01). The HIV group had 27% with an abnormal pattern requiring immunofixation which revealed nine (12.5% of total) had oligoclonal bands, seven (10.3% of total) had polyclonal hypergammaglobulinaemia and three (4% of total) had monoclonal bands. CD4+ counts were lower in those with polyclonal hypergammaglobulinaemia or abnormal serum protein electrophoresis. Interestingly, viral load results showed no statistically significant differences.
We found a remarkably high level (53%) of polyclonal hypergammaglobulinaemia in our untreated population compared with uninfected controls (10%). Only 4% of the HIV-positive group had a monoclonal band. Polyclonal hypergammaglobulinaemia correlated significantly with lower CD4+ counts. These results highlight the generalized B cell stimulation in untreated HIV infection. Future longitudinal studies will be important to determine the prognostic value of these findings.
在人类免疫缺陷病毒（HIV）感染中存在B淋巴细胞刺激现象，这会导致免疫球蛋白持续产生，并伴有异常的血清蛋白电泳图谱。我们推测，未经治疗的HIV感染者血清蛋白电泳图谱会出现异常，且与疾病严重程度标志物相关。
对70名HIV阳性、临床状况良好且未接受过治疗的受试者以及42名HIV阴性对照者进行血清蛋白电泳，并将其与疾病严重程度标志物（即CD4+细胞计数、病毒载量、IgG和白蛋白）进行关联分析。
两组的平均年龄均为33岁，男女比例均为4:1。所有受试者均为黑人。HIV组和对照组的平均CD4细胞计数±标准差分别为419.5±218.6个/mm³和960.4±378.5个/mm³。在HIV感染组中，44%表现为多克隆高丙种球蛋白血症，而对照组为10%（P<0.01）。HIV组中有27%的人电泳图谱异常，需要进行免疫固定电泳分析，结果显示其中9人（占总数的12.5%）有寡克隆带，7人（占总数的10.3%）有多克隆高丙种球蛋白血症，3人（占总数的4%）有单克隆带。多克隆高丙种球蛋白血症或血清蛋白电泳异常者的CD4+细胞计数较低。有趣的是，病毒载量结果无统计学显著差异。
与未感染的对照组（10%）相比，我们发现未经治疗的人群中多克隆高丙种球蛋白血症的水平显著较高（53%）。HIV阳性组中只有4%的人有单克隆带。多克隆高丙种球蛋白血症与较低的CD4+细胞计数显著相关。这些结果突出了未经治疗的HIV感染中普遍存在的B细胞刺激现象。未来的纵向研究对于确定这些发现的预后价值将非常重要。
