Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden.
Adv Exp Med Biol. 2020;1294:105-125. doi: 10.1007/978-3-030-57616-5_8.
Immunoglobulins are key effector molecules in the humoral immune response. Intravenous polyspecific immunoglobulin (IVIG) is a preparation of polyclonal serum immunoglobulins, typically IgG, from thousands of donors. It has been used as adjunctive therapy in critically ill patients with severe infections, i.e. sepsis, septic shock, and necrotizing soft tissue infections. IVIG has been used for patients with severe invasive group A streptococcal infection since the early nineties and off-label use of IVIG for necrotizing soft tissue infections is common. It is also used for a variety of autoimmune, inflammatory, and immunodeficiency diseases. A meta-analysis of the clinical studies available for IVIG use in group A streptococcal toxic shock syndrome indicates a survival benefit. A blinded, placebo-controlled clinical trial (INSTINCT) assessed the effect of IVIG in 100 intensive care unit patients with necrotizing soft tissue infections, including all bacterial etiologies. The study did not demonstrate any effect on self-reported physical functioning at 6 months. In this chapter, we review the mechanisms of action of IVIG and the clinical studies that are available for necrotizing soft tissue infections as well as severe group A streptococcal infections.
免疫球蛋白是体液免疫反应中的关键效应分子。静脉注射多特异性免疫球蛋白（IVIG）是一种由数千名供体的多克隆血清免疫球蛋白（通常是 IgG）组成的制剂。它已被用作严重感染（即败血症、感染性休克和坏死性软组织感染）危重症患者的辅助治疗。自 90 年代初以来，IVIG 已用于治疗严重侵袭性 A 组链球菌感染的患者，并且 IVIG 治疗坏死性软组织感染的超适应证使用很常见。它还用于治疗各种自身免疫性疾病、炎症性疾病和免疫缺陷性疾病。一项针对 IVIG 在 A 组链球菌中毒性休克综合征中的临床研究的荟萃分析表明，IVIG 具有生存获益。一项盲法、安慰剂对照临床试验（INSTINCT）评估了 IVIG 在 100 例坏死性软组织感染的重症监护病房患者中的作用，包括所有细菌病因。该研究未在 6 个月时显示出对自我报告的身体机能有任何影响。在本章中，我们将回顾 IVIG 的作用机制以及可用于治疗坏死性软组织感染和严重 A 组链球菌感染的临床研究。
