소아 신증후군에서 IgG 아군 및 바이러스 항체 값
The Levels of IgG Subclasses and Vaccine-induced Viral Antibodies in Childhood Minimal Change Nephrotic Syndrome
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목 적 : 소아 신증후군에서 알부민을 비롯한 단백들과 IgG 치의 감소가 관찰된다. 신증후군에서 관찰되는 IgG 감소에서 IgG 아군간에 차이가 있는 지와 B형 간염 및 홍역 항체의 양성률이 대조군과 차이가 있는지를 알아보았다. 방 법 : 가톨릭대학교 대전성모병원 소아과에 신증후군으로 입원하였던 21명과 같은 연령대의 건강한 환아 25명을 대상으로, 혈청에서 IgG, IgM, IgA, IgE 및 IgG subclasses(IgG1, IgG2, IgG3 및 IgG4), B형 간염 표면 항체(anti-hepatitis B surface IgG, anti-HBs IgG) 및 항홍역 IgG 항체(anti-measles IgG)를 측정하였다.결 과 : 신증후군 환아들의 평균 연령 6.9±3.0세로, 면역글로불린 평균값은 IgG 390±187 mg/ dL, IgG1 287±120 mg/dL를 보였다. 대조군의 평균 연령은 7.5±3.4세로, IgG 1,025±284 mg/ dL, IgG1 785±19 mg/dL이었다. IgE 값에서 250 IU/mL 이상을 보인 경우는 신증후군에서 11명(52.4%), 대조군에서 7명(28%)이 있었다(P= 0.01). 신증후군 환아에서 IgG 및 IgG 아군 모두에서 유의한 감소를 보였으며(P<0.001), IgM 값은 증가(251±183 mg/dL vs. 153±55 mg/dL, P=0.02)를 보였으나 IgA 값은 차이를 보이지 않았다. 한편 Anti-HBs의 양성률은 신증후군 환아군에서 42.9%(21명 중 9명), 대조군에서 52% (13/25명)를, 항홍역 항체 양성률은 각각 76% (16/21명)와 92% (23/25명)를 보였으나 통계학적으로 두 군간에 차이는 없었다.
Abstract
Purpose : Hypogammaglobulinemia has been observed in nephrotic syndrome, but its pathophysiology remains unknown. We evaluated serum immunoglobulins, IgG subclasses, and vaccine-induced viral antibodies(anti-hepatitis B surface IgG and anti-measles IgG) in children with minimal change nephrotic syndrome(MCNS). Methods : Using the stored sera, the levels of immunoglobulin(IgG, IgM, IgA, and IgE) and IgG subclasses(IgG 1, 2, 3, and 4), anti-HBs Ab and anti-measles IgG of 21 children with MCNS were analyzed and compared to those of 25 age-matched healthy children. Results : The mean values of IgG and IgG1 were 390±187 mg/dL and 287±120 mg/dL in nephrotic children, and 1,025±284 mg/dL and 785±19 mg/dL in control children, respectively. The values of the total IgG and the 4 IgG subclasses in nephrotic children were all significantly depressed(P<0.001), but the IgM(251±183 mg/dL vs. 153±55 mg/dL, P=0.02) and IgE values(P=0.01) were elevated, and the IgA values were not changed. The seropositivity of anti-HBs IgG was 42.9%(9 of 21 cases) in the MCNS group and 52%(13/25) in the control group, and that of anti-measles IgG was 76%(16/21) and 92%(23/25), respectively, but there was no statistical difference between the two groups. Conclusion : IgG and IgG subclass levels in MCNS children are all depressed without significant seronegativity of the vaccine-induced viral antibodies. Further studies are needed to resolve the cause of hypogammaglobulinemia in MCNS.
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