高原期骨髓瘤的免疫因素与感染风险
Immunological factors and risk of infection in plateau phase myeloma.
作者信息
Hargreaves R M, Lea J R, Griffiths H, Faux J A, Holt J M, Reid C, Bunch C, Lee M, Chapel H M
机构信息
Department of Immunology, John Radcliffe Hospital, Oxford.
出版信息
J Clin Pathol. 1995 Mar;48(3):260-6. doi: 10.1136/jcp.48.3.260.
AIMS
A series of patients with myeloma were investigated to assess whether immunological risk factors predisposing to serious infection could be identified.
METHODS
Patients (n = 102) with predominantly plateau phase myeloma were monitored prospectively for infections. Immunological parameters including total non-paraprotein immunoglobulins and specific antibody titres were measured in all patients and compared with a control population of healthy individuals of a similar age; response to immunisation with Pneumovax II, tetanus and diphtheria toxoids and IgG subclasses were measured in a subgroup of 41 patients. Other characteristics investigated for any association with infection included age, sex, paraprotein type, disease stage, and chemotherapy.
RESULTS
Specific antibody titres to pneumococcal capsular polysaccharides and tetanus and diphtheria toxoids were significantly reduced compared with the control population. Low antipneumococcal and anti Escherichia coli titres correlated with risk of serious infection and low anti-pneumococcal titres with severity of non-paraprotein immunosuppression. In 41 immunised patients responses to Pneumovax II, tetanus and diphtheria toxoids were poor; IgG subclass levels were significantly reduced and a poor IgG response to Pneumovax II immunisation was associated with an increased risk of septicaemia and low IgG2 levels. The overall serious infection rate was 0.92 infections per patient year and was four times higher during periods of active disease (1.90) compared with plateau phase myeloma (0.49). The predominant site of infection was the respiratory tract. Clinical and laboratory parameters showed only male sex and reduced non-paraprotein IgG and IgA levels to be significantly associated with at least one serious infection.
CONCLUSIONS
A subgroup of patients with myeloma with poor IgG responses to exogenous antigens, who are at increased risk of serious infection, can be identified and may benefit from replacement immunoglobulin therapy to reduce the risk of infection.
目的
对一系列骨髓瘤患者进行研究，以评估是否能识别出易导致严重感染的免疫危险因素。
方法
对主要处于平台期骨髓瘤的102例患者进行前瞻性感染监测。测定所有患者的免疫参数，包括总非副蛋白免疫球蛋白和特异性抗体滴度，并与年龄相仿的健康个体对照组进行比较；对41例患者的亚组测定其对肺炎球菌疫苗II、破伤风和白喉类毒素免疫接种的反应以及IgG亚类。研究其他与感染相关的特征，包括年龄、性别、副蛋白类型、疾病分期和化疗情况。
结果
与对照组相比，肺炎球菌荚膜多糖、破伤风和白喉类毒素的特异性抗体滴度显著降低。抗肺炎球菌和抗大肠杆菌滴度低与严重感染风险相关，抗肺炎球菌滴度低与非副蛋白免疫抑制的严重程度相关。在41例接受免疫接种的患者中，对肺炎球菌疫苗II、破伤风和白喉类毒素的反应较差；IgG亚类水平显著降低，对肺炎球菌疫苗II免疫接种的IgG反应差与败血症风险增加和IgG2水平低相关。总体严重感染率为每年每位患者0.92次感染，与平台期骨髓瘤（0.49）相比，疾病活动期（1.90）的感染率高出四倍。感染的主要部位是呼吸道。临床和实验室参数显示，只有男性以及非副蛋白IgG和IgA水平降低与至少一次严重感染显著相关。
结论
可识别出一组对外源性抗原IgG反应差、严重感染风险增加的骨髓瘤患者，他们可能受益于替代免疫球蛋白治疗以降低感染风险。
Zotero 插件