Odat Haitham, Alqudah Mohannad
Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan.
Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3189-93. doi: 10.1007/s00405-016-3981-x. Epub 2016 Mar 14.
The purpose of this study is to readdress the issue of primary humoral immunodeficiency frequency and pattern in medically resistant chronic rhinosinusitis (CRS) based on the new guidelines for CRS diagnosis and management. Two hundred and fifty-seven consecutive patients with refractory CRS were included in this study. The results of their IgA, IgM, IgG, and IgG subclasses were analyzed and compared with 75 age- and gender-matched control groups. The average age of CRS patients was 34 years (SD ± 13). In the refractory CRS group, there was no significant difference between patients with or without humoral immunodeficiency based on age, gender and status of allergy, polyps and revision. Low level of one of the major immunoglobulin isotypes was found in 15 patients (6 %). Six patients had low IgG, two had low IgA, and seven had low IgM. IgG subclasses were low in 37 patients (14 %), and IgG4 was the most common deficient subclass. Multiple immunoglobulins deficiencies were found in eight patients. Compared with the control group, CRS patients had a significant higher prevalence of major immunoglobulins as well as total major immunoglobulins and IgG subclasses deficiency. Because of high prevalence of subtle humoral immunodeficiency in medically resistant CRS and inability to find unique clinical and demographic characteristic of these patients, we recommend routine screening of major immunoglobulins and IgG subclasses on the group of CRS patients who failed medical treatment.
本研究的目的是根据慢性鼻-鼻窦炎（CRS）诊断和管理的新指南，重新探讨药物难治性慢性鼻-鼻窦炎中原发性体液免疫缺陷的频率和模式问题。本研究纳入了257例连续的难治性CRS患者。分析了他们的IgA、IgM、IgG和IgG亚类的结果，并与75个年龄和性别匹配的对照组进行比较。CRS患者的平均年龄为34岁（标准差±13）。在难治性CRS组中，基于年龄、性别以及过敏、息肉和再次手术状态，有或无体液免疫缺陷的患者之间无显著差异。15例患者（6%）发现一种主要免疫球蛋白亚型水平较低。6例患者IgG水平低，2例患者IgA水平低，7例患者IgM水平低。37例患者（14%）的IgG亚类水平低，且IgG4是最常见的缺乏亚类。8例患者发现多种免疫球蛋白缺乏。与对照组相比，CRS患者主要免疫球蛋白以及总主要免疫球蛋白和IgG亚类缺乏的患病率显著更高。由于药物难治性CRS中轻微体液免疫缺陷的患病率高，且无法找到这些患者独特的临床和人口统计学特征，我们建议对药物治疗失败的CRS患者组进行主要免疫球蛋白和IgG亚类的常规筛查。
