静脉注射丙种球蛋白在新生儿疾病中的应用

周欢; 陈雨霏; 陈筱青

doi:10.16766/j.cnki.issn.1674-4152.002200

静脉注射丙种球蛋白在新生儿疾病中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002200

南京医科大学第一附属医院儿科，江苏南京 210029

基金项目:

国家自然科学基金面上项目 81871195

江苏省妇幼健康科研项目 F201745

详细信息

通讯作者:
陈筱青，E-mail: xqchen@njmu.edu.cn

中图分类号: R722
计量
- 文章访问数: 337
- HTML全文浏览量: 531
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2021-07-15
- 网络出版日期: 2022-02-15

Application of intravenous gamma globulin in neonatal diseases

Department of Pediatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China

摘要

摘要: 新生儿是人类迈向独立生存的初始阶段，需面对各种各样的挑战和难关，如感染关，但作为主力军的免疫系统发育不完善，防御薄弱、抵抗力不足，易罹患感染性疾病如新生儿感染性肺炎、新生儿败血症、新生儿化脓性脑膜炎、新生儿病毒性脑炎、新生儿肠道病毒性心肌炎等，这些疾病的发生发展影响着新生儿的生存质量，严重者会影响患儿预后，增加家庭负担；同时，新生儿体内从母体血液中获得的还未代谢完成的自身免疫性抗体会造成新生儿的免疫损伤如新生儿溶血病、新生儿红斑狼疮、新生儿血色素沉着症、新生儿同种免疫性血小板减少症、新生儿同种免疫性中性粒细胞减少症、暂时性新生儿重症肌无力等，母源性免疫性疾病部分会随着抗体的代谢完全而缓解，但过渡阶段仍会提升新生儿死亡率。另外，还有一类与免疫功能紊乱相关的疾病如川崎病、新生儿缺氧缺血性脑病、新生儿自身免疫性水疱病、巨噬细胞活化综合征、吉兰-巴雷综合征、僵人综合征等，虽新生儿群体不是其好发人群，但也会偶现其中一种或几种疾病，影响患儿生命。这三大类疾病均可通过静脉注射丙种球蛋白的辅助治疗获得有益的效果。此外，静脉注射丙种球蛋白制剂具有某些病原体的抗体活性，对免疫接种具有一定影响。故本文就丙种球蛋白在新生儿疾病中应用的潜在机制进行综述。
- 静脉注射丙种球蛋白 /
- 新生儿 /
- 新生儿疾病
Abstract: Compared with foetus, newborns have undergoing tremendous physiological changes. However, their immune system is weak and insufficient. Thus, newborns are susceptible to infectious diseases, such as neonatal infectious pneumonia, neonatal sepsis, neonatal purulent meningitis, neonatal viral encephalitis and neonatal enteroviral myocarditis. The occurrence and development of these diseases affect the quality of life and the prognosis of newborns, which increase the burden on the family. At the same time, the autoimmune antibodies, obtained from the mother's blood but have not been metabolised, can cause immune damage to the newborn, such as neonatal haemolytic disease, neonatal lupus erythematosus, neonatal hemochromatosis, neonatal alloimmune thrombocytopaenia, neonatal alloimmune neutropaenia and temporary neonatal myasthenia gravis. Some of these diseases are relieved following the metabolism of antibodies but still increase neonatal mortality. In addition, some diseases are related to immune dysfunction, such as Kawasaki disease, hypoxic-ischemic encephalopathy, neonatal autoimmune blistering disease, macrophage activation syndrome, Guillain-Barré syndrome and stiff-person syndrome. Although they are not common in the newborn population, one or more of these diseases will occasionally occur. Adjuvant therapy using intravenous gamma globulin can effectively treat these diseases. In addition, gamma globulins have similar ability to antibodies against certain antigens, so they have a certain impact on vaccination. This article reviews the potential mechanism of gamma globulins in neonatal diseases.
- Intravenous gamma globulin /
- Newborns /
- Neonatal diseases

HTML全文

参考文献(41)

[1]	YU J C, KHODADADI H, MALIK A, et al. Innate immunity of neonates and infants[J]. Front Immunol, 2018, 9: 1759. doi: 10.3389/fimmu.2018.01759
[2]	ALSALEEM M. Intravenous immune globulin uses in the fetus and neonate: A review[J]. Antibodies (Basel), 2020, 9(4): 60. doi: 10.3390/antib9040060
[3]	OHLSSON A, LACY J B, OHLSSON ALACY J B. Intravenous immunoglobulin for preventing infection in preterm and/or low birth weight infants[J]. Cochrane Database Syst Rev, 2020, 1(1): CD000361. DOI: 10.1002/14651858.CD000361.
[4]	张亚维, 康文清, 熊虹, 等. 静脉用丙种球蛋白辅助治疗新生儿重症肺炎的回顾性分析[J]. 中国当代医药, 2017, 24(3): 89-91. doi: 10.3969/j.issn.1674-4721.2017.03.028
[5]	周挺, 方建江, 李增攀, 等. 丙种球蛋白对脓毒症患者免疫状态及血清炎性因子的影响[J]. 中华全科医学, 2020, 18(2): 229-232. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202002017.htm
[6]	JARCZAK D, KLUGE SNIERHAUS A. Sepsis-pathophysiology and therapeutic concepts[J]. Front Med (Lausanne), 2021, 8(609). DOI: 10.3389/fmed.2021.628302.
[7]	SHANKAR-HARI M, MADSEN M B, TURGEON A F. Immunoglobulins and sepsis[J]. Intensive Care Med, 2018, 44(11): 1923-1925. doi: 10.1007/s00134-018-5047-6
[8]	OHLSSON A, LACY J B. Intravenous immunoglobulin for suspected or proven infection in neonates[J]. Cochrane Database Syst Rev, 2020, 1(1): CD001239. DOI: 10.1002/14651858.CD001239.pub6.
[9]	PUTATUNDA R, BETHEA J R, HU W H. Potential immunotherapies for traumatic brain and spinal cord injury[J]. Chin J Traumatol, 2018, 21(3): 125-136. doi: 10.1016/j.cjtee.2018.02.002
[10]	许邦礼, 康文清. 新生儿重症化脓性脑膜炎临床特征分析[J]. 中国小儿急救医学, 2021, 28(4): 312-315. doi: 10.3760/cma.j.issn.1673-4912.2021.04.015
[11]	CHEN H, SOUAYAH N. Immunoglobulins reduced oxidative stress in human microglial cells induced by high dose of acetoacetate[J]. Brain Res, 2020. DOI: 10.1016/j.brainres.2020.147054.
[12]	林阳, 杨亚琼, 陈宁, 等. 丙种球蛋白治疗我国临床诊断病毒性脑炎有效性的Meta分析[J]. 中国循证医学杂志, 2021, 21(8): 898-906. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202108005.htm
[13]	WAGNER J N, LEIBETSEDER A, TROESCHER A, et al. Efficacy and safety of intravenous immunoglobulins for the treatment of viral encephalitis: A systematic literature review[J]. J Neurol, 2021. DOI: 10.1007/s00415-021-10494-w.
[14]	MAISCH B, ALTER P. Treatment options in myocarditis and inflammatory cardiomyopathy: Focus on i. v. immunoglobulins[J]. Herz, 2018, 43(5): 423-430. doi: 10.1007/s00059-018-4719-x
[15]	ROBINSON J, HARTLING L, VANDERMEER B, et al. Intravenous immunoglobulin for presumed viral myocarditis in children and adults[J]. Cochrane Database Syst Rev, 2020, 8(8): CD004370. DOI: 10.1002/14651858.CD004370.
[16]	胡雨生, 尹同进, 雍其军, 等. 静脉注射人免疫球蛋白治疗新生儿急性肺损伤/呼吸窘迫综合征的效果[J]. 安徽医学, 2018, 39(2): 155-158. doi: 10.3969/j.issn.1000-0399.2018.02.007
[17]	HAGIWARA J, YAMADA M, MOTODA N, et al. Intravenous immunoglobulin attenuates cecum ligation and puncture-induced acute lung injury by inhibiting apoptosis of alveolar epithelial cells[J]. J Nippon Med Sch, 2020, 87(3): 129-137. doi: 10.1272/jnms.JNMS.2020_87-303
[18]	ZWIERS C, VAN DER BOM J G, VAN KAMP I L, et al. Postponing early intrauterine transfusion with intravenous immunoglobulin treatment; the PETIT study on severe hemolytic disease of the fetus and newborn[J]. Am J Obstet Gynecol, 2018, 219(3): 291. http://www.ncbi.nlm.nih.gov/pubmed/29902448
[19]	REE I M C, SMITS-WINTJENS V, VAN DER BOM J G, et al. Neonatal management and outcome in alloimmune hemolytic disease[J]. Expert Rev Hematol, 2017, 10(7): 607-616. doi: 10.1080/17474086.2017.1331124
[20]	VANONI F, LAVA S A G, FOSSALI E F, et al. Neonatal systemic lupus erythematosus syndrome: a comprehensive review[J]. Clin Rev Allergy Immunol, 2017, 53(3): 469-476. doi: 10.1007/s12016-017-8653-0
[21]	NAIR J, KUMAR V H S. Liver failure and conjugated hyperbilirubinemia in a preterm neonate: role of early IVIG and exchange transfusion[J]. AJP Rep, 2018, 8(2): e95-e98. doi: 10.1055/s-0038-1649339
[22]	WINKELHORST D, OEPKES D. Foetal and neonatal alloimmune thrombocytopenia[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 58(7): 15-27. http://www.onacademic.com/detail/journal_1000041582576699_ff44.html
[23]	PORCELIJN L, DE HAAS M. Neonatal alloimmune neutropenia[J]. Transfus Med Hemother, 2018, 45(5): 311-316. doi: 10.1159/000492949
[24]	GRAETER S, SCHNEIDER C, VERSCHOOR D, et al. Enhanced pro-apoptotic effects of Fe(Ⅱ)-modified IVIG on human neutrophils[J]. Front Immunol, 2020, 11(5): 973. http://www.researchgate.net/publication/341488205_Enhanced_Pro-apoptotic_Effects_of_FeII-Modified_IVIG_on_Human_Neutrophils/download
[25]	WILF-YARKONI A, LOTAN I, STEINER I, et al. Chronic low-dose intravenous immunoglobulins as steroid-sparing therapy in myasthenia gravis[J]. J Neurol, 2021. DOI: 10.1007/s00415-021-10544-3.
[26]	AHMED A R, KAVERI S. Reversing autoimmunity combination of rituximab and intravenous immunoglobulin[J]. Front Immunol, 2018, 9(7): 1189. http://www.onacademic.com/detail/journal_1000040525269910_18c6.html
[27]	广东省医师协会儿科医师分会, 《中国当代儿科杂志》编辑部. 静脉注射用免疫球蛋白在儿童血液/肿瘤性疾病中应用的儿科专家共识[J]. 中国当代儿科杂志, 2021, 23(4): 319-327. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ202104001.htm
[28]	钱颖, 王有成, 方晓丹, 等. 大剂量丙种球蛋白联合阿司匹林对川崎病患儿T淋巴细胞亚群、血管内皮因子、炎症因子水平的影响[J]. 中华全科医学, 2017, 15(3): 454-456. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201703029.htm
[29]	YAHATA T, HAMAOKA K. Oxidative stress and Kawasaki disease: How is oxidative stress involved from the acute stage to the chronic stage?[J]. Rheumatology (Oxford), 2017, 56(1): 6-13. doi: 10.1093/rheumatology/kew044
[30]	HAUSSLER V, DAEHN T, RISSIEK B, et al. Intravenous immunoglobulin (IVIg) induce a protective phenotype in microglia preventing neuronal cell death in ischaemic stroke[J]. Neuromolecular Med, 2020, 22(1): 121-132. doi: 10.1007/s12017-019-08571-5
[31]	THOM V, ARUMUGAM T V, MAGNUS T, et al. Therapeutic potential of intravenous immunoglobulin in acute brain injury[J]. Front Immunol, 2017, 8(7): 875. doi: 10.3389/fimmu.2017.00875/pdf
[32]	ENK A, HADASCHIK E, EMING R, et al. European guidelines (S1) on the use of high-dose intravenous immunoglobulin in dermatology[J]. J Dtsch Dermatol Ges, 2017, 15(2): 228-241. doi: 10.1111/ddg.13013
[33]	贝斐, 金燕樑, 孙建华, 等. 母亲成人Still病伴发新生儿巨噬细胞活化综合征一例报告并文献复习[J]. 中华新生儿科杂志(中英文), 2018, 33(6): 446-449.
[34]	BUDA P, GIETKA P, KSiYK J B, et al. The influence of various therapeutic regimens on early clinical and laboratory response and outcome of children with secondary hemophagocytic lymphohistiocytosis[J]. Arch Med Sci, 2018, 14(1): 138-150. http://www.onacademic.com/detail/journal_1000040550754410_b574.html
[35]	罗涵予, 蒋莉. 吉兰-巴雷综合征免疫治疗及预后评估研究进展[J]. 中华实用儿科临床杂志, 2019, 34(24): 1907-1908, 1910. doi: 10.3760/cma.j.issn.2095-428X.2019.24.018
[36]	ORTIZ J F, GHANI M R, MORILLO COX A, et al. Stiff-Person syndrome: A treatment update and new directions[J]. Cureus, 2020, 12(12): e11995. http://www.researchgate.net/publication/347530149_Stiff-Person_Syndrome_A_Treatment_Update_and_New_Directions
[37]	上海市疾病预防控制中心, 杭州市疾病预防控制中心, 苏州市疾病预防控制中心, 等. 特殊健康状态儿童预防接种专家共识之二十: 静脉注射免疫球蛋白使用者的预防接种[J]. 中国实用儿科杂志, 2019, 34(5): 336-337. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSEK201905003.htm
[38]	SULLIVAN N L, REUTER-MONSLOW M A, SEI J, et al. Breadth and functionality of varicella-zoster virus glycoprotein-specific antibodies identified after zostavax vaccination in humans[J]. J Virol, 2018, 92(14): e00269-18. DOI: 10.1128/JVI.00269-18.Print2018Jul15.
[39]	焦富勇, 高晨娜, 王菊艳, 等. 川崎病与疫苗接种的研究共识[J]. 中国妇幼健康研究, 2019, 30(2): 137-141. doi: 10.3969/j.issn.1673-5293.2019.02.002
[40]	GUO Y, TIAN X, WANG X, et al. Adverse effects of immunoglobulin therapy[J]. Front Immunol, 2018, 9(6): 1299.
[41]	ELAJEZ R, EZZELDIN AGABER H. Safety evaluation of intravenous immunoglobulin in pediatric patients: a retrospective, 1-year observational study[J]. Ther Adv Drug Saf, 2019. DOI: 10.1177/2042098619876736.