Résumé
INTRODUCTION: Common variable immunodeficiency is characterized by defective antibody production and recurrent pulmonary infections. Intravenous immunoglobulin is the treatment of choice, but the effects of Intravenous immunoglobulin on pulmonary defense mechanisms are poorly understood. OBJECTIVE: The aim of this study was to verify the impact of intravenous immunoglobulin on the physical properties of the sputum and on inflammatory alterations in the airways of patients with Common variable immunodeficiency associated with bronchiectasis. METHOD: The present study analyzed sputum physical properties, exhaled NO, inflammatory cells in the sputum, and IG titers in 7 patients with Common variable immunodeficiency and bronchiectasis with secretion, immediately before and 15 days after Intravenous immunoglobulin. A group of 6 patients with Common variable immunodeficiency and bronchiectasis but no sputum was also studied for comparison of the basal IgG level and blood count. The 13 patients were young (age=36±17 years) and comprised predominantly of females (n=11). RESULTS: Patients with secretion presented significantly decreased IgG and IgM levels. Intravenous immunoglobulin was associated with a significant decrease in exhaled NO (54.7 vs. 40.1 ppb, p<0.05), sputum inflammatory cell counts (28.7 vs. 14.6 cells/mm³, p<0.05), and a significant increase in respiratory mucus transportability by cough (42.5 vs. 65.0 mm, p < 0.05). CONCLUSION: We concluded that immunoglobulin administration in Common variable immunodeficiency patients results in significant improvement in indexes of inflammation of the airways with improvement in the transportability of the respiratory mucus by cough.
Sujets)
Adulte , Femelle , Humains , Mâle , Dilatation des bronches , Déficit immunitaire commun variable , Immunoglobulines par voie veineuse/usage thérapeutique , Clairance mucociliaire/physiologie , Infections de l'appareil respiratoire , Expectoration , Dilatation des bronches/traitement médicamenteux , Dilatation des bronches/immunologie , Dilatation des bronches/physiopathologie , Numération cellulaire , Déficit immunitaire commun variable/traitement médicamenteux , Déficit immunitaire commun variable/immunologie , Déficit immunitaire commun variable/physiopathologie , Toux/immunologie , Toux/physiopathologie , Immunoglobuline G/analyse , Immunoglobuline M/analyse , Mucus/physiologie , Monoxyde d'azote/analyse , Infections de l'appareil respiratoire/traitement médicamenteux , Infections de l'appareil respiratoire/immunologie , Infections de l'appareil respiratoire/physiopathologie , Statistique non paramétrique , Expectoration/cytologie , Expectoration/effets des médicaments et des substances chimiques , Expectoration/immunologie , Facteurs tempsRésumé
Se presentan 2 pacientes con bronquiectasia en los cuales se demostró inmunodefiencia común variable (IDCV). Ambos pacientes fueron tratados con gammaglobulina con buena respuesta. Consideramos que el estudio de pacientes con bronquiectasias debe investigarse la IDCV