抗γ-干扰素自身抗体阳性患者5例临床特征分析并文献复习  

Clinical characteristics of 5 patients with anti-interferon-gamma autoantibodies and literature review

作　　者：赖冠廷 梁小娜[1] 宾雁飞[1] 李颖华[1] 张建全[1] 白晶[1] 何志义[1] LAI Guan-ting;LIANG Xiao-na;BIN Yan-fei;LI Ying-hua;ZHANG Jian-quan;BAI Jing;HE Zhi-yi(Department of Respiratory and Critical Care Medicine,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院呼吸与危重症医学科,广西南宁530021 [2]广西壮族自治区工人医院老年医学科

出　　处：《中国实用内科杂志》2020年第10期840-844,849,共6页Chinese Journal of Practical Internal Medicine

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S20180980)。

摘　　要：目的探讨抗γ-干扰素自身抗体阳性患者合并多种机会性病原菌感染病例的临床特点。方法回顾性分析2012年8月至2018年11月广西医科大学第一附属医院呼吸与危重症医学科住院的5例抗γ-干扰素自身抗体阳性合并多种机会性感染患者的临床诊治经过,以抗γ-干扰素自身抗体、机会性感染、成人免疫缺陷综合征为中英文关键词分别检索Pubmed数据库、中国知网数据库及万方数据库,检索时间截至2019年12月,对病例资料进行汇总分析。结果5例患者中,女性2例,男性3例,年龄25~69岁。呼吸道症状:咳嗽、咳痰5例,胸痛3例,气喘2例,血痰1例。肺外症状:发热5例,多发淋巴结肿大5例,皮疹5例,关节痛2例。5例均合并多种机会性病原菌感染。实验室检查:5例患者血清抗γ-干扰素自身抗体阳性,5例血清IgG及血嗜酸性粒细胞均升高,治疗上针对相应病原菌抗感染治疗症状可好转但易复发,5例合并皮疹患者中,2例接受激素治疗均有效但仍复发。文献复习共检索到相关文献105篇,其中综述2篇,病例报告46篇,其它类型文献57篇。结论抗γ-干扰素自身抗体阳性患者常合并多种机会性病原菌感染,最常见为非结核分枝杆菌,常伴有免疫球蛋白异常及嗜酸性粒细胞增高,容易出现皮肤损害。Objective To investigate the clinical features of patients with anti-interferon-gamma autoantibodies who were co-infection with multiple opportunistic pathogens.Methods The clinical diagnosis and treatment of 5 patients with antiinterferon-gamma autoantibodies and co-infection with multiple opportunistic pathogens were retrospectively analyzed.These cases were admitted to the Department of Respiratory and Critical Care Medicine of First Affiliated Hospital of Guangxi Medical University between August 2012 and November 2018.We searched English and Chinese databases,including PubMed,Chinese National Knowledge Infrastructure and Wanfang database.Anti-interferon-γautoantibodies,opportunistic infection and adult-onset immunodeficiency were used as key words.The searching period extended to December 2019.Results The 5 cases included 2 women and 3 men aged 25 to 69 years old.The respiratory symptoms included cough(5/5),sputum(5/5),chest pain(3/5),shortness of breath(2/5),and hemoptysis(1/5).Extra-pulmonary symptoms included fever(5/5),multiple lymphadenopathy(5/5),rash(5/5),and joint pain(2/5).All cases were coinfection with multiple opportunistic pathogens.Laboratory examination:Serum anti-interferon-gamma autoantibodies were positive in all cases and the level of IgG and the percentage of eosinophils increased.The symptoms can be improved after antibiotictherapies for the corresponding pathogens but still relapsed.Of the 5 patients with rash,2 received effective glucocorticoid therapy but dermatosis also recurred.Literature reviewes showed a total of 105 relevant literatures including 2 review,46 case reports and 57 other types of literature.Conclusion Patients with positive anti-interferon gamma autoantibodies are susceptible to co-infection with various opportunistic pathogens.The most common of opportunistic pathogens is nontuberculous mycobacterium.Meanwhile,these patients often accompany with abnormal immunoglobulin and high eosinophilis and skin lesion.

关 键 词：抗γ-干扰素自身抗体 机会性病原菌感染 成人免疫缺陷综合征 马尔尼菲篮状菌 非结核分枝杆菌 

分 类 号：R593.32[医药卫生—内科学]