Martora Fabrizio, Battista Teresa, Giordano Antonella, Potestio Luca, Megna Matteo
Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Clin Cosmet Investig Dermatol. 2025 Jan 7;18:1-5. doi: 10.2147/CCID.S503199. eCollection 2025.
Hypergammaglobulinemia is a sign of B cell and plasma cell hyperactivity marked by elevated levels of gamma globulins, proteins within the gamma fraction of serum electrophoresis, linked to diseases like acute hepatitis, Hodgkin's lymphoma, autoimmune conditions, and neoplasms. Monoclonal gammopathy of undetermined significance (MGUS) is found in 3.2% of individuals over 50 and 5.3% over 70 due to immunosenescence, the gradual immune decline influenced by chronic infections, malnutrition, hormonal dysregulation, and smoking. This retrospective, single-center observational study explored the association between hypergammaglobulinemia and Hidradenitis Suppurativa (HS) based on sex, age, disease severity (IHS4 score), and Adalimumab treatment. Sixty patients (54% women, 46% men, average age 47) were observed over 12 months. Hypergammaglobulinemia was found in 68% of patients, with the highest prevalence in the 15-29 age group (80%). It was also associated with increased disease severity, particularly in younger patients, who showed a reduced clinical response to Adalimumab (average HiSCR difference of 25%). While common inflammation markers like CRP and ESR remain essential for HS management, this study highlighted that hypergammaglobulinemia is more prevalent in younger patients with severe forms of HS. Unlike older patients, where immunosenescence can lead to more normal gamma globulin levels, younger patients demonstrated a strong link between chronic inflammation and disease. The findings suggest further investigation is needed to determine whether hypergammaglobulinemia is merely a marker or contributes to HS pathogenesis. If validated, hypergammaglobulinemia could be used to monitor disease progression and customize treatments. In conclusion, integrating immunological assessments into HS management could improve patient outcomes, particularly in younger demographics. With larger studies, hypergammaglobulinemia might be considered a predictive factor for HS, especially for severe or treatment-resistant cases.
高球蛋白血症是B细胞和浆细胞过度活跃的标志，其特征是γ球蛋白水平升高，γ球蛋白是血清电泳γ区带中的蛋白质，与急性肝炎、霍奇金淋巴瘤、自身免疫性疾病和肿瘤等疾病有关。由于免疫衰老，即受慢性感染、营养不良、激素失调和吸烟影响的逐渐免疫衰退，在50岁以上的个体中，意义未明的单克隆丙种球蛋白病（MGUS）的发生率为3.2%，70岁以上为5.3%。这项回顾性、单中心观察性研究基于性别、年龄、疾病严重程度（IHS4评分）和阿达木单抗治疗，探讨了高球蛋白血症与化脓性汗腺炎（HS）之间的关联。在12个月内观察了60例患者（54%为女性，46%为男性，平均年龄47岁）。68%的患者存在高球蛋白血症，在15 - 29岁年龄组中患病率最高（80%）。它还与疾病严重程度增加有关，尤其是在年轻患者中，这些患者对阿达木单抗的临床反应降低（平均HiSCR差异为25%）。虽然像CRP和ESR等常见炎症标志物对HS的管理仍然至关重要，但这项研究强调高球蛋白血症在患有严重形式HS的年轻患者中更为普遍。与老年患者不同，免疫衰老会导致γ球蛋白水平更正常，而年轻患者表现出慢性炎症与疾病之间的紧密联系。研究结果表明，需要进一步研究以确定高球蛋白血症仅仅是一个标志物还是对HS发病机制有影响。如果得到验证，高球蛋白血症可用于监测疾病进展并定制治疗方案。总之，将免疫评估纳入HS管理可以改善患者预后，特别是在年轻人群中。通过更大规模的研究，高球蛋白血症可能被视为HS的预测因素，尤其是对于严重或难治性病例。
