Fujiwara T, Taniuchi S, Hattori K, Kobayashi T, Kinoshita Y, Kobayashi Y
Department of Paediatrics, Kansai Medical University, Moriguchi, Osaka, Japan.
Clin Exp Immunol. 1997 Mar;107(3):435-9. doi: 10.1046/j.1365-2249.1997.d01-957.x.
There has been some disagreement as to the clinical effect of intravenous immunoglobulin (IVIG) therapy on neonatal bacterial infections. We therefore evaluated the effect of IVIG therapy on neonatal polymorphonuclear leucocyte (PMN) functions by monitoring phagocytosis and hydrogen peroxide (H2O2) production. Subjects were 10 mature neonates who had normal plasma levels (i.e. equal to adult plasma levels) of IgG and nine premature neonates who had lower plasma levels of IgG. Phagocytosis by PMN was measured using flow cytometric analysis of whole blood. Addition of gamma-globulin to the whole blood of mature neonates increased phagocytosis, but not significantly. Higher doses of added gamma-globulin (> 2.0 mg/ml, the concentration was expressed as that in the final reaction volume) decreased phagocytosis to under baseline level. In premature neonates addition of gamma-globulin increased phagocytosis and the significant maximum effect was observed with 0.5 mg/ml of the additional gamma-globulin. Higher doses of additional gamma-globulin (2.5 mg/ml) decreased phagocytosis to baseline level. Phagocytosis in four mature and four premature neonates was compared before and after 1 g/kg of IVIG therapy. Phagocytosis in mature neonates after IVIG therapy did not change compared with the pretreatment level. On the other hand, phagocytosis in premature neonates after IVIG therapy significantly increased compared with its pretreatment level. In both mature and premature neonates H2O2 production following phagocytosis varied in parallel with changes of phagocytosis. The patterns of H2O2 production following phagocytosis were essentially similar to those observed with phagocytosis. The above results are expected to form the basis for a rational indication for IVIG therapy against bacterial infections in neonates with low plasma IgG levels.
关于静脉注射免疫球蛋白（IVIG）疗法对新生儿细菌感染的临床效果存在一些分歧。因此，我们通过监测吞噬作用和过氧化氢（H2O2）生成来评估IVIG疗法对新生儿多形核白细胞（PMN）功能的影响。研究对象为10名成熟新生儿，其血浆IgG水平正常（即与成人血浆水平相等），以及9名血浆IgG水平较低的早产新生儿。使用全血流式细胞术分析来测量PMN的吞噬作用。向成熟新生儿的全血中添加丙种球蛋白可增加吞噬作用，但不显著。添加更高剂量的丙种球蛋白（>2.0 mg/ml，浓度以最终反应体积中的浓度表示）会使吞噬作用降至基线水平以下。在早产新生儿中，添加丙种球蛋白可增加吞噬作用，在添加0.5 mg/ml丙种球蛋白时观察到显著的最大效果。更高剂量（2.5 mg/ml）的额外丙种球蛋白会使吞噬作用降至基线水平。比较了4名成熟和4名早产新生儿在接受1 g/kg IVIG治疗前后的吞噬作用。与治疗前水平相比，成熟新生儿接受IVIG治疗后的吞噬作用没有变化。另一方面，早产新生儿接受IVIG治疗后的吞噬作用与其治疗前水平相比显著增加。在成熟和早产新生儿中，吞噬作用后H2O2的生成与吞噬作用的变化平行。吞噬作用后H2O2的生成模式与吞噬作用观察到的模式基本相似。上述结果有望为合理应用IVIG治疗血浆IgG水平低的新生儿细菌感染提供依据。
