成人亚类免疫球蛋白浓度异常者的肺炎球菌疫苗接种反应。

Pneumococcal vaccination responses in adults with subnormal IgG subclass concentrations.

机构信息

The Binding Site Group Limited, 8 Calthorpe Road, Birmingham, B15 1QT, UK.

Southern Iron Disorders Center, Birmingham, AL, USA.

出版信息

BMC Immunol. 2019 Aug 20;20(1):29. doi: 10.1186/s12865-019-0310-3.

BACKGROUND

We sought to compare Pneumovax®23 responses in adults with subnormal IgG subclass concentrations. We studied adults with normal total IgG, frequent/severe respiratory infection, and subnormal IgG1, IgG3, or IgG1 + IgG3 before and after Pneumovax®23. We defined response as serotype-specific IgG > 1.3 μg/mL and aggregate response as IgG > 1.3 μg/mL for ≥70% of all serotypes tested. We compared patients with and without serotype-specific responses and performed logistic regression on aggregate responses using: age; male sex; body mass index; autoimmune condition(s); atopy; other allergies; subnormal IgGSc immunophenotypes; IgA; and IgM.

RESULTS

There were 59 patients (mean age 44 ± 13 (SD) years; 83.1% women). Median days between pre- and post-Pneumovax®23 testing was 33 (range 19-158). The median post-vaccination summated concentration of serotype-specific IgG was higher in patients with subnormal IgG1 than subnormal IgG3 (responders and non-responders). All subnormal IgG1 + IgG3 non-responders responded to serotypes 8, 9 and 26, unlike other non-responders. Subnormal IgG3 responders had lower responses to serotypes 1, 4, 12, 23, 26, and 51. Subnormal IgG3 non-responders had higher responses to serotypes 1, 3, 8, 9, 12, 14, 19, 51, and 56. Response rates decreased with increasing age. Aggregate responders were: subnormal IgG1, 54%; IgG3, 46%; and IgG1 + IgG3, 46%. Regression on aggregate response revealed lower response with male sex (odds ratio 0.09 [95% CI 0.01, 0.77]) and atopy (0.17 [0.03, 0.83]).

CONCLUSIONS

Serotype-specific IgG responses to Pneumovax®23 were greater in patients with subnormal IgG1 than subnormal IgG3. Male sex and atopy were associated with lower aggregate responses.

背景

我们旨在比较亚类免疫球蛋白 IgG 浓度异常的成年人中沛儿 23 型的反应。我们研究了总 IgG 正常、频繁/严重呼吸道感染且 IgG1、IgG3 或 IgG1+IgG3 亚类免疫球蛋白 IgG 浓度异常的成年人，在接种沛儿 23 型疫苗前后进行了检测。我们将血清型特异性 IgG ＞1.3μg/mL 定义为有反应，将所有检测血清型 IgG ＞1.3μg/mL 的比例≥70%定义为总体 IgG 有反应。我们比较了有和无血清型特异性反应的患者，并对总体 IgG 反应进行了逻辑回归分析，分析变量包括年龄、男性、体重指数、自身免疫性疾病、特应性、其他过敏、亚类免疫球蛋白 IgG 免疫表型异常、IgA 和 IgM。

结果

共有 59 例患者（平均年龄 44±13 岁；83.1%为女性）。接种沛儿 23 型疫苗前后检测的中位时间间隔为 33 天（范围 19-158 天）。与 IgG3 亚类免疫球蛋白浓度异常的患者相比，IgG1 亚类免疫球蛋白浓度异常的患者接种疫苗后的血清型特异性 IgG 总和浓度更高（有反应者和无反应者）。与其他无反应者不同，所有 IgG1+IgG3 亚类免疫球蛋白浓度异常的无反应者对血清型 8、9 和 26 有反应。IgG3 亚类免疫球蛋白有反应者对血清型 1、4、12、23、26 和 51 的反应较低。IgG3 亚类免疫球蛋白无反应者对血清型 1、3、8、9、12、14、19、51 和 56 的反应较高。随着年龄的增加，反应率下降。总体 IgG 有反应者包括：IgG1 亚类免疫球蛋白浓度异常者 54%、IgG3 亚类免疫球蛋白浓度异常者 46%和 IgG1+IgG3 亚类免疫球蛋白浓度异常者 46%。对总体 IgG 反应的回归分析显示，男性（比值比 0.09[95%CI 0.01，0.77]）和特应性（0.17[0.03，0.83]）与较低的总体 IgG 反应相关。