84例自身免疫性溶血性贫血IgG抗体亚型与临床意义的分析

目的　研究温抗体型自身免疫性溶血性贫血ＩｇＧ亚型及其临床意义。方法　回顾性分析８４ 例患者ＩｇＧ亚型与临床特点的关系。结果　８４ 例患者中ＩｇＧ１ ＋ＩｇＧ３ ＋ Ｃ３ｄ 型占４５．０％ ，ＩｇＧ１ ＋ＩｇＧ３型占１５ ．５％ ，ＩｇＧ１ ＋ Ｃ３ｄ型占１１．０％ ，Ｃ３ｄ型占１０ ．７％ ，ＩｇＧ１ 型占９．５％ ，ＩｇＧ３ ＋ Ｃ３ｄ占８．３ ％ 。各型中均以女性为主，合计占６９ ．５％ 。ＩｇＧ３ 阳性各型的临床表现相似，各项临床指标异常最严重；ＩｇＧ１ 阳性的各型次之；Ｃ３ｄ 型最轻。Ｈｂ＜６０ ｇ／Ｌ、总胆红素＞ ４０ μｍｏｌ／Ｌ、ＦＨｂ＞ ６０ ｍｇ／Ｌ的患者百分率三组间比较，差异有显著性（Ｐ＜０ ．０５） 。ＩｇＧ１ 型与ＩｇＧ３ 型都随Ｃｏｏｍｂｓ 试验积分增高，其临床表现及溶血程度加重。ＩｇＧ３ 阳性的患者治疗有效率为６８ ．２％ ，ＩｇＧ１ 阳性患者有效率为１００％ 。结论　ＩｇＧ 亚型中以ＩｇＧ１ ＋ＩｇＧ３ 为主。ＩｇＧ３ 阳性的患者临床表现及溶血程度严重，治疗效果差

The clinical inplications of IgG subclass in 84 patients with autoimmune hemolytic anemia

OBJECTIVE: To evaluate the clinical implications of IgG subclass in autoimmune hemolytic anemia(AIHA). METHODS: Data of 84 AIHA patients were retrospectively analyzed. RESULTS: In the 84 patients, IgG1 + IgG3 + C3d accounted for 45.0%, IgG1 + IgG3 15.5%, IgG1 + C3d 11.0%, C3d 10.7%, IgG1 9.5% and IgG3 + C3d 8.3%. IgG3 patients had the most severity of clinical and laboratory findings, followed by IgG1 patients. In IgG1 and IgG3 subgroups, the severity of hemolysis was positively correlated with the score of Coombs' test. The response rates of IgG3 and IgG1 patients were 68.2% and 100%, respectively. CONCLUSION: In AIHA, the basic predominant IgG subclass is IgG1. IgG3 has a greater potential for red-cell destruction than IgG1 and C3d.