血清低IgG与溃疡性结肠炎关系研究
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摘要
目的探讨血清低免疫球蛋白G(Ig G)与溃疡性结肠炎(UC)的关系。方法 2010年1月至2017年6月期间在北京协和医院住院确诊的73例UC患者被纳入研究,对低Ig G和正常IgG两组患者的临床资料进行回顾性分析。结果 73例UC患者中血清IgG降低的UC患者12例(16.4%)。低Ig G水平的UC患者与IgG水平正常患者相比,超敏C反应蛋白水平显著增高[(47.82±29.89)mg/L对(32.89±36.45)mg/L,P=0.048),重度患者比例明显增高(100%对31.1%,P<0.001)。且低IgG水平UC患者伴发巨细胞病毒(CMV)感染明显增多(61.5%对27.8%,P=0.018)。低IgG水平UC患者较IgG水平正常者激素治疗有效比例显著降低(16.7%对69.8%,P=0.002)。利用受试者工作特征(ROC)曲线分析,IgG水平在6.73 g/L及以上时,预测糖皮质激素治疗有效的敏感度为97.4%,特异度为41.2%。结论血清Ig G可能会成为预测UC患者病情严重程度及激素治疗效果的有价值临床指标。
Objective To investigate the relationship between low serum immunoglobulin G(Ig G) and ulcerative colitis(UC). Methods A total of 73 cases of UC in Peking Union Medical College Hospital from January 2010 to June 2017 were enrolled, and the clinical data of patients with low serum Ig G and normal serum Ig G were comparatively analyzed retrospectively. Results Twelve(16.4%) of 73 patients with UC had low serum Ig G. Compared with pa tients with normal serum Ig G, the level of high-sensitivity C-reactive protein(hs CRP) was significantly higher and severe cases were obviously more in those patients with low serum Ig G [(47.82±29.89)mg/L vs(32.89±36.45)mg/L, P=0.048 and 100% vs 31.1%, P <0.0001]. In terms of concurrent infection, cytomegalovirus(CMV) infection was more frequent in UC patients with low serum Ig G(61.5% vs 27.8%, P =0.018). The effective rate after corticosteroid therapy in low serum Ig G group was dramatically lower than that in normal serum Ig G group(16.7% vs 69.8%, P=0.002). The sensitivity and specificity of predicting corticosteroid effectiveness by ROC curve was 97.4% and 41.2% at cut-off value of 6.73 g/L for Ig G. Conclution Serum Ig G level may serve as a promising clinical indicator to predict the disease severity and effectiveness of corticosteroid treatment in the patients with UC.
Objective To investigate the relationship between low serum immunoglobulin G(Ig G) and ulcerative colitis(UC). Methods A total of 73 cases of UC in Peking Union Medical College Hospital from January 2010 to June 2017 were enrolled, and the clinical data of patients with low serum Ig G and normal serum Ig G were comparatively analyzed retrospectively. Results Twelve(16.4%) of 73 patients with UC had low serum Ig G. Compared with pa tients with normal serum Ig G, the level of high-sensitivity C-reactive protein(hs CRP) was significantly higher and severe cases were obviously more in those patients with low serum Ig G [(47.82±29.89)mg/L vs(32.89±36.45)mg/L, P=0.048 and 100% vs 31.1%, P <0.0001]. In terms of concurrent infection, cytomegalovirus(CMV) infection was more frequent in UC patients with low serum Ig G(61.5% vs 27.8%, P =0.018). The effective rate after corticosteroid therapy in low serum Ig G group was dramatically lower than that in normal serum Ig G group(16.7% vs 69.8%, P=0.002). The sensitivity and specificity of predicting corticosteroid effectiveness by ROC curve was 97.4% and 41.2% at cut-off value of 6.73 g/L for Ig G. Conclution Serum Ig G level may serve as a promising clinical indicator to predict the disease severity and effectiveness of corticosteroid treatment in the patients with UC.
引文
[1]钱家鸣,杨红.中国炎症性肠病研究的历史回顾现状和展望[J].中国实用内科杂志,2015,35(9):727-730.
[2]Gouni-Berthold I,Baumeister B,Berthold HK,et al.Immunoglobulins and Ig G subclasses in patients with inflammatory bowel disease[J].Hepatogastroenterology,1999,46(27):1720-1723.
[3]Rai T,Wu X,Shen B.Frequency and risk factors of low immunoglobulin levels in patients with inflammator y bowel disease[J].Gastroenterol Rep(Oxf),2015,3(2):115-121.
[4]Rogosnitzky M,Danks R,Holt D.Intravenous immunoglobulin for the treatment of Crohn’s disease[J].Autoimmun Rev,2012,12(2):275-280.
[5]Chrissafidou A,Malek M,Musch E.Experimental study on the use of intravenous immunoglobulin(IVIg)in patients with steroid-resistant Crohn’s disease[J].Z Gastroenterol,2007,45(7):605-608.
[6]童锦禄,冉志华.炎症性肠病诊断和鉴别诊断中的难点以及中国面临的问题[J].中国实用内科杂志,2015,35(9):731-734.
[7]Horton N,Wu X,Philpott J,et al.Impact of low immunoglobulin g levels on disease outcomes in patients with inflammatory bowel diseases[J].Dig Dis Sci,2016,61(11):3270-3277.
[8]Sapir T,Blank M,Shoenfeld Y.Immunomodulator y effects of intravenous immunoglobulins as a treatment for autoimmune diseases,cancer,and recurrent pregnancy loss[J].Ann N Y Acad Sci,2005,1051:743-778.
[9]B?hm S,K ao D,Nimmer jahn F.Sweet and sour:the role of glycosylation for the anti-inflammatory activity of immunoglobulin G[J].Curr Top Microbiol Immunol,2014,382:393-417.
[10]Yomota M,Amano I,Horita N,et al.Serum immunoglobulin G is a marker for the risk of opportunistic infection in steroid-dependent severe asthmatic patients[J].Intern Med,2012,51(19):2715-2719.
[11]Zhou L,Fang F,Jiang J,et al.Changes of immunity function in cytomegalovirus infection[J].Immunol J,2003,19(1):59-64.
[2]Gouni-Berthold I,Baumeister B,Berthold HK,et al.Immunoglobulins and Ig G subclasses in patients with inflammatory bowel disease[J].Hepatogastroenterology,1999,46(27):1720-1723.
[3]Rai T,Wu X,Shen B.Frequency and risk factors of low immunoglobulin levels in patients with inflammator y bowel disease[J].Gastroenterol Rep(Oxf),2015,3(2):115-121.
[4]Rogosnitzky M,Danks R,Holt D.Intravenous immunoglobulin for the treatment of Crohn’s disease[J].Autoimmun Rev,2012,12(2):275-280.
[5]Chrissafidou A,Malek M,Musch E.Experimental study on the use of intravenous immunoglobulin(IVIg)in patients with steroid-resistant Crohn’s disease[J].Z Gastroenterol,2007,45(7):605-608.
[6]童锦禄,冉志华.炎症性肠病诊断和鉴别诊断中的难点以及中国面临的问题[J].中国实用内科杂志,2015,35(9):731-734.
[7]Horton N,Wu X,Philpott J,et al.Impact of low immunoglobulin g levels on disease outcomes in patients with inflammatory bowel diseases[J].Dig Dis Sci,2016,61(11):3270-3277.
[8]Sapir T,Blank M,Shoenfeld Y.Immunomodulator y effects of intravenous immunoglobulins as a treatment for autoimmune diseases,cancer,and recurrent pregnancy loss[J].Ann N Y Acad Sci,2005,1051:743-778.
[9]B?hm S,K ao D,Nimmer jahn F.Sweet and sour:the role of glycosylation for the anti-inflammatory activity of immunoglobulin G[J].Curr Top Microbiol Immunol,2014,382:393-417.
[10]Yomota M,Amano I,Horita N,et al.Serum immunoglobulin G is a marker for the risk of opportunistic infection in steroid-dependent severe asthmatic patients[J].Intern Med,2012,51(19):2715-2719.
[11]Zhou L,Fang F,Jiang J,et al.Changes of immunity function in cytomegalovirus infection[J].Immunol J,2003,19(1):59-64.