Roifman C M, Gelfand E W
Division of Immunology and Rheumatology, Hospital for Sick Children, Toronto, Canada.
Pediatr Infect Dis J. 1988 May;7(5 Suppl):S92-6.
In the last 30 years patients with antibody deficiency have benefited remarkably from regular replacement therapy with intramuscular immune serum globulin. In a proportion of patients this approach has not been successful in preventing sinopulmonary infections and progressive deterioration. The introduction of preparations of immune serum globulin suitable for intravenous administration provided the potential for examining the effects of achieving higher serum IgG levels. We have therefore evaluated and compared high vs low dose therapy in patients with hypogammaglobulinemia and sinopulmonary disease. To achieve minimum trough serum IgG levels of 500 mg/dl, we administered 0.6 g/kg every 4 weeks. High dose therapy proved efficacious in reducing symptoms, decreasing the frequency of major and minor infections and significantly improving pulmonary function. The improvement appeared to correlate with a marked reduction in the isolation of Mycoplasma, particularly Urea-plasma urealyticum, an important cause of infection in patients with hypogammaglobulinemia. High dose therapy with immune serum globulin suitable for intravenous administration appears to be the treatment of choice in patients with sinopulmonary disease.
在过去30年里，抗体缺乏患者从定期肌内注射免疫血清球蛋白替代疗法中受益匪浅。然而，在一部分患者中，这种方法未能成功预防鼻窦肺部感染和病情进展恶化。适合静脉给药的免疫血清球蛋白制剂的出现，为研究提高血清IgG水平的效果提供了可能。因此，我们评估并比较了低剂量与高剂量疗法对低丙种球蛋白血症和鼻窦肺部疾病患者的疗效。为使血清IgG谷值水平达到最低500mg/dl，我们每4周给予0.6g/kg的剂量。高剂量疗法在减轻症状、减少严重和轻微感染频率以及显著改善肺功能方面被证明是有效的。这种改善似乎与支原体，尤其是解脲脲原体的分离量显著减少有关，解脲脲原体是低丙种球蛋白血症患者感染的一个重要原因。适合静脉给药的免疫血清球蛋白高剂量疗法似乎是鼻窦肺部疾病患者的首选治疗方法。
