静脉注射用丙种球蛋白治疗新生儿ABO溶血病对血清免疫球蛋白的影响

目的通过新生儿ABO溶血病使用静脉注射用丙种球蛋白(IVIG)前后的血清免疫球蛋白指标变化观察,探讨IVIG使用对新生儿血清免疫球蛋白的影响.方法随机将新生儿ABO溶血症患儿分为两组,常规治疗+IVIG为治疗组,常规治疗为对照组,IVIG治疗剂量为800～1000mg/kg,分别测定使用IVIG前,使用IVIG后2 d、28 d、2个月体内血清免疫球蛋白数值并与对照组对照.结果治疗组IgG、IgM在用药后2 d、IgA在用药后28d与对照组比较差异有显著性,其余指标两组差异无显著性.结论IVIG治疗新生儿ABO溶血病不会使新生儿IgG的合成受抑制,但使IgM、IgA的合成在短期内受到抑制.     

静脉注射免疫球蛋白治疗新生儿ABO溶血病

目的 探讨静脉注射免疫球蛋白（IVIG0）治疗新生儿ABO溶血病的疗效。方法 将32例分为IVIG治疗组和常规治疗组，IVIG治疗组在常规治疗的基础上，静脉予IVIG。两组均在治疗前后检查血清总胆红素、末梢毛细血管红细胞计数（RBC）、血红蛋白（Hb）和红细胞压积（HCT）。结果 治疗3－4dIVIG组在皮肤黄疸消退时间及血清胆红素降低斋成于常规治疗组（P均＜0．001），两组在光疗时间无明显差异（P＞0．05）；常规治疗组的末梢毛细血管RBC、Hb和HCT显著低于治疗前（P均＜0．001），而IVIG组的三项指标治疗前后均无明显差异（P＞0．05）。结论 IVIG以降低新生儿ABO溶血病患儿的血清胆红素有显著疗效，可有效地防止或减轻溶血和高胆红素血症。     

静脉内丙种球蛋白两种疗法治疗新生儿ABO溶血病的疗效研究

目的 探讨应用静脉内丙种球蛋白(IVIG)治疗新生儿ABO溶血病两种疗法的效果.方法 将我院新生儿病房2003～2006年间收治的新生儿ABO溶血病患儿102例随机分为两组:对照组(50例)采用IVIG 3 d疗法[0.4 g/(kg·d),连用3 d];治疗组(52例)采用IVIG 1 d疗法[1 g/(kg·d),单剂静脉滴注],两组进行疗效对比.结果 治疗组在治疗后48 h、72 h血清总胆红素较对照组降低(P＜0.05),黄疸消退时间与对照组比较明显缩短(P＜0.01).结论 1 d疗法在疗效方面明显优于3 d疗法,采用IVIG1g/(kg·d)单剂静脉滴注是治疗新生儿ABO溶血病更有效、经济、简便的治疗方案.     

大剂量静脉滴注丙种球蛋白治疗新生儿ABO溶血病的疗效观察

目的　观察大剂量静脉滴注丙种球蛋白(IVIG)治疗新生儿ABO溶血病的临床效果。方法　对符合新生儿ABO溶血病诊断标准且无其它合并症的63例患儿,分为常规治疗组和大剂量IVIG治疗组。IVIG治疗组在常规治疗的基础上给予IVIG80 0mg/kg·d静脉滴注,每日一次,连续3日。结果　IVIG治疗组在治疗前血清胆红素水平比较高的情况下,黄疸消退时间为4 1 8±1 0 3天,常规治疗组为5 .2 8±1 .5 0天,t=3.72 4 ,P <0.0 1。结论　大剂量静脉滴注丙种球蛋白协同治疗新生儿ABO溶血病临床效满意     

交换输血术对高胆红素血症新生儿血清免疫球蛋白的影响

目的 评估高胆红素血症新生儿的体液免疫状态及其进行交换输血治疗(换血术)前后的血清免疫球蛋白(Ig)水平变化情况,了解换血术对新生儿血清Ig的影响.方法 对62例高胆红素血症新生儿进行换血治疗,治疗前后分别测定其血清Ig(IgG、IgA、IgM)水平,并依据病因分成ABO溶血病组、Rh溶血病组、脓毒症组和其他组进行分析.结果 1.换血术前:ABO溶血病组、Rh溶血病组IgG水平均显著高于脓毒症组及其他组(Pa＜0.01),各组间IgA、IgM水平无明显差异(Pa>0.05).2.换血术后ABO溶血病组、Rh溶血病组IgG水平均较换血前显著下降(Pa＜0.05);其他组及脓毒症组IgG水平均较换血前升高,但差异无统计学意义(P=0.387,0.091).3.换血后4组IgA水平均较换血前升高,且其他组、ABO溶血病组和Rh溶血病组治疗前后比较差异有统计学意义(Pa=0.000),脓毒症组治疗前后无统计学意义(P=0.185).4.换血后4组IgM水平均较换血前升高,其他组、ABO溶血病组和Rh溶血病组治疗前后比较均有统计学意义(Pa＜0.05),但脓毒症组治疗前后无统计学意义(P=0.081);且其他组、ABO溶血病组和Rh溶血病组各组间治疗后比较有统计学意义(P＜0.01).结论 1.新生儿溶血病患儿术前血清IgG水平较高,换血术能迅速降低溶血病患儿血IgG水平,提升患儿血IgA、IgM水平;2.换血术对脓毒症患儿血清IgG、IgA、IgM的水平无明显影响;3.换血术能提高其他高胆红素血症患儿血清IgA、IgM水平,但对血清IgG水平无明显影响.     

静脉注射丙种球蛋白治疗新生儿ABO溶血病22例疗效观察

为探讨静脉注射丙种球蛋白 (IVIG)对新生儿 ABO溶血病的疗效 ,随机将 42例 ABO溶血病新生儿分为 IVIG治疗组和常规治疗组 ,两组均于治疗前和治疗后分别查血红蛋白 ,网织红细胞、血清胆红素及 Ig G.A.M。结果 :IVIG组在皮肤黄疸消退 ,降低血清胆红素疗效方面均明显优于常规组 (P<0 .0 1 ) ,Ig G水平明显提高 (P<0 .0 1 ) Ig A与 Igm水平无变化 (P>0 .0 5 ) ;常规组在治疗 3～ 4天后血红蛋白水平显著低于治疗前 (P<0 .0 1 ) ,而 IVIG组血红蛋白水平与治疗前无显著性差异 (P>0 .0 5 ) ,IVIG投药量为 40 0 mg/kg.d、6 0 0 mg/kg.d、80 0 mg/kg.d,三种剂量均显示有效 ,以 80 0 mg/kg.d组退黄效果明显 ,但比较无统计学意义 (P>0 .0 5 )。结论 :IVIG对新生儿 ABO溶血病有确切疗效 ,有较高的临床使用价值     

新生儿破伤风应用静脉丙种球蛋白的免疫效果

探讨国产人血静脉丙种球蛋白(IVIG)辅助治疗新生儿破伤风的临床疗效及免疫功能。将40例新生儿破伤风患儿按病例编号分为常规组和IVIG组各20例。常规组采用破伤风抗毒素及安定类药物治疗;IVIG组在常规治疗组方案基础上加用IVIG(400mg/kg·d,静脉点滴,每日一次)共3天。并设20例健康新生儿作对照组。检测血清IgA、IgG、IgM和外周血T淋巴细胞亚群。比较实验前后的临床疗效和免疫功能变化。结果显示:①新生儿破伤风患儿血清IgG、CD_3、CD_4水平明显低于健康对照组;②静脉注射IVIG后,可迅速提高新生儿破伤风患儿血清IgG水平(5.86±0.62vs11.71±1.46)g/L,同时可提高CD_4细胞数(32.55±2.51vs44.23±4.87)和CD_4/CD_8比值(1.30±0.19 vs 2.10±0.11),P均<0.001;③IVIG组治愈率为85％,明显高于常规组55％,(x~2=4.28,P<0.05)。而平均治愈天数由(14.55±2.78)d缩短为(10.50±2.54)d(t=4.13,P<0.001)。病死率由20%降至10%。结论:免疫功能紊乱可能与新生儿破伤风有关。适宜的IVIG剂量辅助治疗新生儿破伤风,疗效肯定,副作用少,值得临床推广。     

静脉丙种球蛋白两种方法治疗新生儿ABO溶血病的疗效研究

新生儿ABO溶血病是新生儿早期高胆红素血症的主要原因之一，严重者可发生胆红素脑病，早期需积极治疗。我院自2003年1月至2006年12月采用静脉丙种球蛋白（IVIG）1d疗法（贵阳黔峰生物制品有限责任公司生产，5％2.5g／支）治疗新生儿ABO溶血病52例，3d疗法50例，以观察其疗效并进行疗效对比。     

不同剂量丙种球蛋白治疗ABO溶血病疗效比较

目的比较不同剂量静脉注射用丙种球蛋白(IVIG)治疗新生儿ABO血型不合溶血病的疗效。方法将出生后2 d内确诊的新生儿ABO血型不合溶血病患儿随机分为单剂组(70例)和多剂组(66例),单剂组静脉滴注IVIG 1 g/(kg.d),1 d;多剂组剂量500 mg/(kg.d),共3 d。生后第42天随访血红蛋白及生长发育等情况。结果单剂组需要双面光疗时间较多剂组短(P<0.01),两组患儿第42天血红蛋白水平、贫血发生率差异无显著性,两组患儿均不需换血治疗,均未发生胆红素脑病。结论单次大剂量IVIG(1 g/kg)治疗新生儿ABO血型不合溶血病是一种高效、经济、安全的治疗方法。     

新生儿窒息后血清免疫球蛋白和补体变化

目的 观察新生儿窒息缺氧后血清免疫球蛋白和补体的变化。方法 应用散射速率比浊法进行窒息新生儿及健康新生儿血清免疫球蛋白IgG、IgM、IgA及补体C3、C4的检测。结果 新生儿窒息后IgM、C3明显降低，与正常对照组比较，差异有显著意义；重度窒息组与轻度窒息组比较IgM差异有显著意义；窒息后第10天与窒息后第5天比较，IgM、C3、C4有显著上升，而IgG、IgA差异无显著意义。结论 新生儿窒息缺氧后血清免疫球蛋白IgM和补体C3、C4可降低，且与窒息的严重程度呈正相关，随着窒息程度的好转，IgM及补体C3、C4可逐渐恢复正常。     

Exchange transfusion or intravenous immunoglobulin therapy as an adjunct to antibiotics for neonatal sepsis in developing countries: a pilot study

Both intravenous administration of immunoglobulin (IVIG) and exchange transfusion (ET) have been used for treatment of neonatal sepsis. No studies have compared ET with IVIG in neonates. AIM: The aim of the study was to investigate serial IgG and IgM serum levels in two groups of septic infants treated with either IVIG or ET as adjuvant therapy. RESULTS: A total of 88 infants with sepsis and gestational ages ranging from 32 to <37 weeks were enrolled consecutively. The effect of ET with fresh, whole blood and IVIG on immunoglobulin G and M levels was monitored over a 24-hour period. ET was performed on 33 infants, 33 infants received IVIG and 22 infants served as controls. There were nine deaths (27%) in the IVIG group, seven (21%) in the ET group and nine (41%) in the control group (p>0.05). IgG levels rose significantly 12 hours after administration of IVIG (p<0.01). There were no differences between the initial and 24-hour IgG levels in the IVIG group. IgG levels did not change significantly in the ET and control groups. IgM levels rose significantly 12 hours after ET and elevated IgM levels persisted for over 24 hours.     

Intestinal Absorption of Immunoglobulins by Newborn Infants

Intestinal absorption in newborn infants of immunoglobulins present in colostrum was studied by measuring the concentrations of immunoglobulins IgA, IgG, and IgM in cord blood and following the changes in the serum of the infant on the 5th day after birth. In infants who did not receive colostrum, a marked fall in IgG levels was observed on the 5th day after birth as compared to levels at birth. The concentrations of IgA and IgM showed marginal changes. In contrast, colostrumfed infants showed significant increases in the concentration of IgG. Levels of all 3 immunoglobulins on the 5th day were significantly higher in the serum of colostrumfed infants as compared to those who did not receive colostrum. It is suggested that immunoglobulins present in colostrum are to some extent absorbed from the intestinal tract of newborn infants, and this may have some physiological significance in the resistance to infection during the early neonatal period.     

Serial IgG and IgM serum levels after infusion of different Ig-preparations (IgG or IgM-enriched) in preterm infants

Intravenous administration of Immunoglobulin (IVIG) has been used for prevention or treatment of neonatal sepsis. However, therapeutic efficacy of IVIG is dependent on pharmacokinetic factors. There have been no comparative studies in neonates between licensed IgG and IgM enriched preparations. The aim of this study was to investigate serial IgG and IgM serum levels during the neonatal period in two groups of non-septic, preterm infants treated prophylactically with IVIG. Twenty-two very low birth weight (VLBW) patients (1001-1500g) (gestational age 31.8±2.0 weeks and 1265±245g birth weight) and 12 extremely low birth weight (ELBW) patients (<1000g) (gestational age 28.6±2.5 weeks and 910-85g birth weight) received at random three standard doses of Sandoglobulin (SG) (0. 5 g/kg/day) or IgM enriehed Pentaglobin (PG) (5 ml/kg/day). IgG and IgM concentrations were assayed by rate nephelometry before treatment and at day 3, 5, 7, 14 and 28 of life. At any time IgG levels were higher in the SG-VLBW group (p < 0.01). no difference being observed in the ELBW group (p>0.5). IgM levels were higher at day 3 and 5 in the PG-VLBW group and until day 7 in the ELBW group (p < 0.01). This study indicates a wide range of IgG and IgM kinetics in the healthy premature and suggests frequent monitoring of immunoglobulin serum levels during efficacy studies.     

Intestinal absorption of IgA in the newborn

The aim of this study was to establish whether or not the newborn can absorb IgA from colostrum, using two feeding regimens. Single radial immunodiffusion on commercial Behring plates was used for IgA quantitation. In group A, 30 mature newborn infants born by vaginal delivery and fully breast fed, cord serum IgA concentration was 0.0990 +/- 0.0294 mg/ml (means +/- SEM). IgA was detectable in 9 of 30 infants. On the 3rd day of life, IgA concentration in serum was 0.3610 +/- 0.0194 mg/ml (means +/- SEM). It was detectable in all 30 infants; on the 5th day of life, its concentration was 0.4293 +/- 0.0365 mg/ml (means +/- SEM). In group B, 39 newborn infants born by cesarean section and fed boiled human milk exclusively, IgA was not detected either in cord, or in venous blood on the 3rd and 5th day of life. The rise of serum IgA in breast-fed newborn infants, highly significant from the 1st to the 3rd day of life (p less than 0.0001), and its increase between the 3rd and 5th day, although not significant, was in distinct contrast to the undetectable serum IgA in newborn infants fed boiled human milk. These data strongly suggest that IgA absorption from colostrum occurs at least until the 3rd day of life.     

Detection of high risk pregnancies with relation to ABO haemolytic disease of newborn

IgM and IgG anti A and anti B antibody status of 100 antenatal O group mothers (who had non O group husbands) were studied. Of these, 3 mothers had an IgM anti A antibody levels ranging from 1 : 512 to 1 : 2048 and IgG ranging from 1 : 1204 to 1 : 2048, IgM anti B ranging from 1 : 128 to 1 : 512 and IgG anti B ranging from 1 : 256 to 1 : 512. All these mothers had A + ve children and all these children suffered from ABO haemolytic disease of newborn (HDN). A 4th mother had an IgM anti A titre of 1 : 64 and IgG anti A titre of 1 :16. The titre of IgM anti B in this mother was 1 : 512 and that of IgG 1 : 1024. The child was A + ve and did not suffer from ABO haemolytic disease of newborn.     

Transfer of antibodies across the placenta and in breast milk from mothers on intravenous immunoglobulin

We studied the levels of immunoglobulins in colostrum, milk and sera from two common variable immunodeficiency (CVID) mothers (M1 and M2), and in sera from their newborn infants. During pregnancy they continued intravenous immunoglobulin therapy (IVIG). Antibody levels from maternal and cord blood collected at delivery and colostrum and milk, collected on the 3rd and 7th post‐partum days, respectively, were analyzed. Although cord/maternal blood ratios of total immunoglobulins and subclasses, as well as specific antibodies differed between M1 and M2, both showed good placental transfer of anti‐protein and anti‐polysaccharide antibodies, despite lower cord/maternal blood ratios in M2. Anti‐Streptococcus pneumoniae antibody avidity indexes were similar between paired maternal and cord serum. Both mothers’ colostrum and milk samples showed only traces of IgA, and IgM and IgG levels in colostrum were within normal range in M1, whereas M2 presented elevated IgG and low IgM levels, when compared with healthy mothers. The study of colostrum and milk activity showed that they strongly inhibited enteropathogenic Escherichia coli adhesion in vitro. CVID patients must be informed about the relevance of regular IVIG administration during pregnancy, not only for their own health but also for their immune immature offspring. Breast‐feeding should be encouraged as colostra from these CVID patients strongly inhibited E. coli adhesion to human epithelial cells thus providing immunological protection plus nutritional and psychological benefits for the infant.     

Effect of fresh frozen plasma and gammaglobulin on humoral immunity in neonatal sepsis.

Fresh frozen plasma and intravenous immunoglobulin are used as prophylaxis against, and for the treatment of, neonatal infection. It is assumed that any beneficial effect is mediated through the humoral immune factors contained in each preparation. The effect of fresh frozen plasma and intravenous immunoglobulin on humoral immune markers (immunoglobulins and IgG subclasses, complement components and activation products, and C reactive protein) was investigated over a 24 hour period after their randomised administration to 67 infants with suspected infection. Thirty infants without suspicion of infection were studied as controls. Compared with control infants, infants with suspected infection had increased concentrations of C reactive protein, reduced concentrations of fibronectin, and increased concentrations of the complement activation marker C3d, but similar concentrations of IgG, IgG subclasses, IgA, and IgM. After intravenous immunoglobulin treatment (500 mg/kg) concentrations of total IgG and all IgG subclasses increased, as did IgA and complement component C4. Concentrations of C reactive protein decreased after intravenous immunoglobulin treatment and were significantly lower than baseline after 24 hours. In contrast, no change in IgG or IgG subclass concentrations occurred after fresh frozen plasma administration. At 24 hours after fresh frozen plasma administration, concentrations of IgA, IgM, and C4 were significantly higher than baseline and serum IgA was significantly higher than in infants tested 24 hours after intravenous immunoglobulin treatment. These results confirm the rational basis for intravenous immunoglobulin treatment but question the value of fresh frozen plasma, particularly in the light of its attendant problems as an untreated blood product.     

反复肺炎婴幼儿血清β-防御素-1和免疫球蛋白A、G、M水平的研究

目的：通过检测反复肺炎婴幼儿和健康婴幼儿血清中β-防御素-1（hBD-1）和免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）浓度,探讨hBD-1和IgA、IgG、IgM在反复肺炎发病中的可能作用。方法：收集35例2~24月龄反复肺炎和35例健康婴幼儿的血清,处理后应用酶联免疫吸附法（ELISA）检测血清中hBD-1浓度,应用免疫比浊法测定血清IgA、IgG、IgM浓度,并分析血清hBD-1与IgA、IgG、IgM之间的相关性。结果：反复肺炎组血清hBD-1浓度为14±11 μg/mL,显著低于健康对照组（18±11 μg/mL）,差异有统计学意义（P0.05）。结论：反复肺炎婴幼儿存在血清hBD-1、IgA、IgG水平低下的现象,提示呼吸道免疫防御功能存在障碍,这可能是婴幼儿反复肺炎的免疫因素之一;对反复肺炎婴幼儿同时检测 hBD-1、IgA、IgG、IgM具有重要的临床意义。     

Plasma Antibodies to Cow's Milk Are Increased by Early Weaning and Consumption of Unmodified Milk, but Production of Plasma IgA and IgM Cow's Milk Antibodies Is Stimulated Even during Exclusive Breast-Feeding

ABSTRACT. We measured levels of cow's milk-specific (CM) antibodies of immunoglobulin classes G, A and M by enzyme-linked immunosorbent assay in plasma of 198 healthy infants; a variable number of samples taken at birth and at ages of 2, 4, 6, 9, 12 and 28 months were available (altogether 765 samples). The rise in the level of IgG CM antibodies was highest and most rapid in infants exposed to CM formula before the age of 1 month. The level fell by 9 months, but rose again by 12 months. This second rise was attributed to the introduction of dairy milk. Partially breast-fed and fully weaned infants had similar levels of IgG CM antibodies. The levels of IgG CM antibodies were unaffected by the infants' own atopy, their heredity for atopy, and the umbilical serum level of IgG CM antibodies. IgA and IgM CM antibodies were absent at birth. Their levels increased similarly in exclusively breast-fed infants and infants fed CM formula. We conclude that plasma IgG antibodies to cow's milk are increased by early weaning and by consumption of unmodified cow's milk. Production of plasma IgA and IgM antibodies to cow's milk is stimulated even during exclusive breast-feeding.