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[静脉注射免疫球蛋白在孕期的应用。一名普通可变免疫缺陷患者的病例报告]

[Use of intravenous immunoglobulin in pregnancy. Report of a patient with common variable immunodeficiency].

作者信息

Cambray-Gutiérrez Julio César, García-Ramírez Ulises Noel, Del Rivero-Hernández Leonel Gerardo, López-Pérez Patricia, Chávez-García Aurora

机构信息

Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Servicio de Alergia e Inmunología Clínica, Ciudad de México, México.

出版信息

Rev Alerg Mex. 2016 Jul-Sep;63(3):311-5. doi: 10.29262/ram.v63i3.152.

Abstract

BACKGROUND

Common variable immunodeficiency is the most commonly-diagnosed primary immunodeficiency in adults; it is characterized by recurrent sinopulmonary and gastrointestinal infections, and increased incidence of malignancy and autoimmune processes. Many patients begin to have clinical manifestations during reproductive age.

CASE REPORT

A 34-year-old woman with 12 weeks of gestation who was diagnosed with common variable immunodeficiency after recurrent episodes of rhinosinusitis, pharyngoamygdalitis, and pneumonia. 0.6 g/kg of IVIG was prescribed every 21 days during the second trimester; the patient only presented one episode of pharyngoamygdalitis, with adequate response to treatment with antibiotics. During the third trimester the dose was adjusted to every 14 days. The patient ended the pregnancy at term without complications, with a child without defects and with proper weight and size.

CONCLUSIONS

The administration of immunoglobulin is the main treatment to control common variable immunodeficiency. While the recommended starting dose is 400-800 mg/kg intravenously every 3 to 4 weeks, there is no consensus on the dose to be used in pregnant women. The recommendation is to perform serum level controls before infusion to determine and adjust it.

摘要

背景

普通可变型免疫缺陷是成人中最常被诊断出的原发性免疫缺陷;其特征为反复发生的鼻窦肺部和胃肠道感染,以及恶性肿瘤和自身免疫过程的发病率增加。许多患者在生育年龄开始出现临床表现。

病例报告

一名34岁妊娠12周的女性,在反复出现鼻窦炎、咽扁桃体炎和肺炎后被诊断为普通可变型免疫缺陷。孕中期每21天静脉注射0.6 g/kg静脉注射免疫球蛋白;患者仅出现一次咽扁桃体炎发作,对抗生素治疗反应良好。孕晚期剂量调整为每14天一次。患者足月分娩,无并发症,孩子无缺陷,体重和尺寸正常。

结论

免疫球蛋白的给药是控制普通可变型免疫缺陷的主要治疗方法。虽然推荐的起始剂量是每3至4周静脉注射400 - 800 mg/kg,但对于孕妇使用的剂量尚无共识。建议在输注前进行血清水平监测以确定并调整剂量。

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