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评估原发性免疫缺陷儿童静脉注射免疫球蛋白替代治疗相关的自身抗体。

Assessment of autoantibodies associated with intravenous immunoglobulin replacement therapy in children with primary immunodeficiency.

机构信息

Department of Pediatric Immunology and Allergy, Dr. Sami Ulus Children's Health and Diseases Training and Research Hospital, Ankara, Turkey.

出版信息

Scand J Immunol. 2024 Nov;100(5):e13396. doi: 10.1111/sji.13396. Epub 2024 Jul 7.

DOI:10.1111/sji.13396
PMID:38973103
Abstract

While it is known that immunoglobulin replacement therapy (IgRT) used in the treatment of primary immunodeficiency disorders (PIDs) can lead to the passive transfer of autoantibodies, there is no data indicating that these antibodies can cause clinical symptoms in patients. This study aimed to investigate the presence of autoantibodies and their clinical correlation in patients diagnosed with PIDs receiving IgRT. Paediatric patients who were diagnosed with PIDs, and administered IgRT at our immunology clinic between 1 January 2012 and 31 December 2021, were included in the study. The medical records of these patients were retrospectively analysed, and autoantibodies were screened. Autoantibody screening was conducted at least once in 48 cases. Among these cases, 29 cases (60.4%) demonstrated positivity for at least one of the autoantibodies screened in the study. Among these cases, 23 tested positive for anti-TPO, 9 for anti-TG and 2 for both anti-TPO and anti-TG. Only two of these patients were confirmed to have Hashimoto's thyroiditis. In 30 cases, autoantibodies related to Celiac disease (CD) were screened, with at least one being positive in five different cases; CD was not confirmed. The results of our study suggest that passive transfer of autoantibodies to patients with IgRT does not cause any significant clinical findings. In addition, in cases of PID, autoantibodies detected in the blood passed to patients with IgRT can lead to misdiagnosis. Screening for autoantibodies in patients with PID undergoing IgRT may not yield accurate results in terms of detecting autoimmune diseases.

摘要

虽然已知免疫球蛋白替代疗法(IgRT)用于治疗原发性免疫缺陷病(PID)会导致自身抗体的被动转移,但尚无数据表明这些抗体可在患者中引起临床症状。本研究旨在调查接受 IgRT 的 PID 患者中自身抗体的存在及其与临床的相关性。

本研究纳入了 2012 年 1 月 1 日至 2021 年 12 月 31 日期间在我院免疫科诊断为 PID 并接受 IgRT 的儿科患者。回顾性分析这些患者的病历,并进行了自身抗体筛查。在 48 例患者中至少进行了一次自身抗体筛查。在这些病例中,29 例(60.4%)至少有一种研究中筛查的自身抗体呈阳性。其中 23 例抗甲状腺过氧化物酶抗体(anti-TPO)阳性,9 例抗甲状腺球蛋白抗体(anti-TG)阳性,2 例同时抗 TPO 和抗 TG 阳性。仅其中 2 例患者被确诊为桥本甲状腺炎。在 30 例患者中筛查了与乳糜泻(CD)相关的自身抗体,在 5 例不同的病例中至少有 1 例呈阳性;但 CD 未被确诊。

我们的研究结果表明,IgRT 患者的自身抗体被动转移不会引起任何明显的临床发现。此外,在 PID 病例中,IgRT 传递给患者的血液中检测到的自身抗体可能导致误诊。在接受 IgRT 的 PID 患者中筛查自身抗体可能无法准确检测自身免疫性疾病。

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