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

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

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。

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,IgG 1+IgG 3+C 3d accounted for 45.0%,IgG 1+IgG 3 15.5%,IgG 1+C 3d 11.0%,C 3d 10.7%,IgG 1 9.5% and IgG 3+C 3d 8.3%.IgG 3 patients had the most severity of clinical and laboratory findings,followed by IgG 1 patients.In IgG 1 and IgG 3 subgroups,the severity of hemolysis was positively correlated with the score of Coombs’ test.The response rates of IgG 3 and IgG 1 patients were 68.2% and 100%,respectively.Conclusion In AIHA,the basic predominant IgG subclass is IgG 1.IgG 3 has a greater potential for red cell destruction than IgG 1 and C 3d .