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常见可变免疫缺陷的诊断:综述

Making a Diagnosis of Common Variable Immunodeficiency: A Review.

作者信息

Ghafoor Asma, Joseph Shona M

机构信息

Allergy and Immunology, Nova Southeastern University School of Osteopathic Medicine, Davie, USA.

出版信息

Cureus. 2020 Jan 20;12(1):e6711. doi: 10.7759/cureus.6711.

Abstract

Common variable immunodeficiency (CVID) is a condition that inhibits the function of the immune system, making those with the condition more susceptible to infection from external pathogens, including bacteria and, less often, viruses. The immune disorder is marked by low immunoglobulin levels of immunoglobulin G (IgG) and IgA as well as IgM in some patients. These immune abnormalities typically result in recurrent sinopulmonary infections and can result in serious complications such as pneumonia and chronic lung disease. Other manifestations include poor vaccine response and defective antibodies in a patient's immune system. The disorder affects approximately one in 25,000 to one in 50,000 individuals worldwide, with the condition varying across different populations. While the underlying mechanism of disease activity remains poorly understood, only 10% of cases are known to have an underlying genetic link and approximately 25% of patients also have an autoimmune disorder. CVID commonly presents in individuals in their twenties or thirties but can present at any time between childhood through adulthood, with mortality dependent on the severity of illness and frequency of recurrent infections. Potential life-threatening consequences of CVID include malignancies, enteropathy, and autoimmune manifestations. Treatment can help alleviate symptoms and prevent continued recurrent infections and serious complications. However, the lack of awareness among primary care physicians (PCPs) makes the condition difficult to diagnose and manage. In this review article, we will provide insight into the clinical manifestations as well as the diagnosis and management of CVID. This will provide clinical practitioners with tools to recognize the disease earlier on to improve patient outcomes and prevent serious complications. We will also afford a better understanding of genetic components tied to CVID and new research efforts.

摘要

普通可变免疫缺陷(CVID)是一种抑制免疫系统功能的疾病,使患者更容易受到外部病原体感染,包括细菌,较少情况下还包括病毒。这种免疫紊乱的特征是免疫球蛋白G(IgG)和IgA水平低,部分患者的IgM水平也低。这些免疫异常通常会导致反复的鼻窦肺部感染,并可能导致严重并发症,如肺炎和慢性肺病。其他表现包括疫苗反应不佳以及患者免疫系统中的抗体缺陷。该疾病在全球约每25000至50000人中就有1人受影响,不同人群的病情有所不同。虽然疾病活动的潜在机制仍知之甚少,但已知只有10%的病例有潜在的遗传联系,约25%的患者还患有自身免疫性疾病。CVID通常在二三十岁的人群中出现,但也可能在儿童期至成年期的任何时候出现,死亡率取决于疾病的严重程度和反复感染的频率。CVID潜在的危及生命的后果包括恶性肿瘤、肠病和自身免疫表现。治疗有助于缓解症状,预防持续的反复感染和严重并发症。然而,初级保健医生(PCP)对此认识不足,使得该病难以诊断和管理。在这篇综述文章中,我们将深入探讨CVID的临床表现以及诊断和管理。这将为临床医生提供工具,以便更早地识别该疾病,从而改善患者预后并预防严重并发症。我们还将更好地理解与CVID相关的遗传成分以及新的研究进展。

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本文引用的文献

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Differentiation of Common Variable Immunodeficiency From IgG Deficiency.
J Allergy Clin Immunol Pract. 2019 Apr;7(4):1277-1284. doi: 10.1016/j.jaip.2018.12.004. Epub 2018 Dec 14.
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