Departement de Médecine Intensive Réanimation, Centre Hospitalier Régional et Universitaire de Brest, site La Cavale Blanche, Université de Bretagne Occidentale, Brest, France.
Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC).
Curr Opin Crit Care. 2019 Oct;25(5):417-422. doi: 10.1097/MCC.0000000000000639.
This review focuses on the emerging literature regarding the use of intravenous immunoglobulins (IVIg) in critically ill patients with severe infections. The aim is to provide an accessible summary of the most recent evidence of IVIg use in sepsis and septic shock and to help clinicians to understand why there is still equipoise regarding the potential benefit of this adjunctive therapy in this setting.
Observational studies with propensity score matching analyses and investigating the effect of IVIg in severe infections including necrotizing soft tissue infection have been recently published. These studies suffer important flaws precluding robust conclusion to be drawn. Some recent randomized controlled trials raised interesting findings supportive of personalized medicine but are likely to be underpowered or confounded.
Insufficient evidence is available to support IVIg use in sepsis and septic shock, apart from the specific case of streptococcal toxic shock syndrome. Current literature suggests that IVIg efficacy in sepsis or septic shock could depend on the IVIg preparation (IgM-enriched or minimal IgM), time of administration (<24 h), dose, and the inflammatory/immunomodulation profile of the patients. Investigator-initiated research, incorporating these parameters, is warranted to determine whether IVIg benefits critically ill patients with severe infection.
本文重点关注关于重症感染患者使用静脉注射免疫球蛋白（IVIg）的新兴文献。目的是提供最近关于 IVIg 在脓毒症和感染性休克中应用的证据概述，并帮助临床医生理解为何在这种情况下，对于这种辅助治疗的潜在益处仍然存在争议。
最近发表了一些观察性研究，采用倾向评分匹配分析，调查 IVIg 在包括坏死性软组织感染在内的严重感染中的作用。这些研究存在重要缺陷，无法得出可靠的结论。一些最近的随机对照试验提出了支持个体化医学的有趣发现，但可能存在效力不足或混杂因素。
除了链球菌中毒性休克综合征的特殊情况外，目前尚无足够证据支持 IVIg 在脓毒症和感染性休克中的应用。目前的文献表明，IVIg 在脓毒症或感染性休克中的疗效可能取决于 IVIg 制剂（富含 IgM 或最小 IgM）、给药时间（<24 小时）、剂量以及患者的炎症/免疫调节特征。有必要开展研究者发起的研究，纳入这些参数，以确定 IVIg 是否有益于重症感染患者。
