Ogi M, Yokoyama H, Tomosugi N, Hisada Y, Ohta S, Takaeda M, Wada T, Naito T, Ikeda K, Goshima S
First Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
Am J Kidney Dis. 1994 Sep;24(3):427-36. doi: 10.1016/s0272-6386(12)80899-7.
Infection has been recognized as an important cause of morbidity and mortality in children with nephrotic syndrome. However, the incidence and severity of infection and the mechanisms responsible for the increased susceptibility to infection are still unclear in adults. We studied 86 consecutive adult patients with nephrotic syndrome but no diabetic nephropathy. Risk factors for infection were evaluated by logistic regression analysis. Infections were found in 16 patients (19%), of whom six died of infection and two developed end-stage renal failure associated with infection. The relative risk for bacterial infection among patients with serum immunoglobulin G (IgG) levels below 600 mg/dL was 6.74 compared with that for patients with serum IgG levels over 600 mg/dL (95% confidence interval, 1.22 to 36.32; P = 0.029). In patients with serum creatinine levels over 2.0 mg/dL, the relative risk of bacterial infection was 5.31 compared with patients with serum creatinine levels below 2.0 mg/dL (95% confidence interval, 1.08 to 26.09; P = 0.040). Intravenous immunoglobulin (10 to 15 g) was administered prospectively every 4 weeks to 18 patients with serum IgG levels below 600 mg/dL until serum IgG levels increased to over 600 mg/dL. Administration of immunoglobulin resulted in a decreased rate of bacterial infections to a level equal to that in patients with endogenous levels over 600 mg/dL. These data indicate that hypogammaglobulinemia and renal insufficiency are independent risk factors for bacterial infection in adult patients with nephrotic syndrome. The effects of intravenous immunoglobulin suggest that maintenance of serum IgG levels over 600 mg/dL may reduce the risk of infection.
感染已被公认为是肾病综合征患儿发病和死亡的重要原因。然而，成人感染的发生率和严重程度以及导致感染易感性增加的机制仍不清楚。我们研究了86例连续的非糖尿病肾病的成人肾病综合征患者。通过逻辑回归分析评估感染的危险因素。16例患者（19%）发生感染，其中6例死于感染，2例因感染发展为终末期肾衰竭。血清免疫球蛋白G（IgG）水平低于600mg/dL的患者发生细菌感染的相对风险为6.74，而血清IgG水平高于600mg/dL的患者为1（95%置信区间，1.22至36.32；P=0.029）。血清肌酐水平高于2.0mg/dL的患者发生细菌感染的相对风险为5.31，而血清肌酐水平低于2.0mg/dL的患者为1（95%置信区间，1.08至26.09；P=0.040）。前瞻性地每4周给18例血清IgG水平低于600mg/dL的患者静脉注射免疫球蛋白（10至15g），直至血清IgG水平升至600mg/dL以上。免疫球蛋白的应用使细菌感染率降至与内源性水平高于600mg/dL的患者相当的水平。这些数据表明，低丙种球蛋白血症和肾功能不全是成人肾病综合征患者发生细菌感染的独立危险因素。静脉注射免疫球蛋白的效果表明，维持血清IgG水平高于600mg/dL可能降低感染风险。
