Summary
Immunoglobulins and aminotransferases were followed in 66 haemophilia patients and 13 von Willebrand patients over a six-year period. The results were correlated to HIV serology and lymphocyte subsets. Elevated IgG levels were found in 29/53 patients with haemophilia A, 2/13 with haemophilia B and in 0/13 with von Willebrand's disease. Elevated IgA and IgM levels were seen in 20% and 27% of the patients respectively, with a distribution similar to the elevated IgG levels, except that elevated IgA and IgM levels were also seen in 4/13 patients with von Willebrand's disease. Patients with HIV antibodies had significantly higher immunoglobulin levels than seronegative patients, and this elevation occurred in connection with seroconversion in the majority of the former. The IgG levels could not be correlated to the T4 cell count, but there has been a trend to less clinical symptoms related to HIV infection among those with stable IgG levels during the past few years. No correlation was found between elevated IgG levels and the aminotransferase levels, nor was any correlation found with the amount of blood coagulation factor concentrate given to the patients. The elevation of immunoglobulins observed in our haemophiliacs is multifactorial, but HIV infection is maybe the most important mechanism. The longitudinal IgG pattern may contribute to the prediction of the clinical outcome of this infection.
Zusammenfassung
Bei 66 Patienten mit Hämophilie und 13 Patienten mit Morbus von Willebrand-Jürgens wurden über einen Zeitraum von sechs Jahren Bestimmungen der Immunglobulin- und Aminotransferase-Spiegel vorgenommen. Die Werte wurden mit der HIV-Serologie und Lymphozyten-Subpopulationen in Beziehung gebracht. Bei 29 von 53 Patienten mit Hämophilie A, zwei von 13 Patienten mit Hämophilie B und keinem von 13 Patienten mit M. von Willebrand-Jürgens fanden sich erhöhte IgG-Spiegel. Erhöhungen der IgA- und IgM-Spiegel fanden sich bei 20 bzw. 27% der Patienten, die Verteilung auf die Gruppen war ähnlich wie bei den IgG-Spiegeln, doch waren auch bei vier der 13 Patienten mit M. von Willebrand-Jürgens Titererhöhungen nachzuweisen. Bei Patienten mit HIV-Antikörpern fanden sich signifikant höhere Immunglobulin-Spiegel als bei seronegativen Patienten; bei der Mehrzahl der Fälle trat die Erhöhung in Verbindung mit der Serokonversion auf. Zwischen der Zahl der T4-Lymphozyten und IgG-Spiegeln fand sich keine Korrelation, doch bestand ein Trend zu geringfügigeren Symptomen der HIV-Infektion, wenn die IgG-Spiegel während der Beobachtungszeit von sechs Jahren stabil war. Die erhöhten IgG-Spiegel korrelierten nicht mit den Aminotransferase-Werten oder der Menge an applizierten Gerinnungsfaktor-Konzentraten. Für die bei unseren Hämophilie-Patienten beobachtete Immunglobulin-Erhöhung kommen viele Ursachen in Frage, doch könnte die HIV-Infektion der wichtigste Faktor sein. Longitudinale IgG-Muster sind möglicherweise als prädiktive Parameter für den klinischen Verlauf dieser Infektion zu verwerten.
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Blombäck, M., Kjellman, H., Pharm, M. et al. Immunoglobulin levels in haemophiliacs at HIV seroconversion and during follow up. Infection 15, 248–252 (1987). https://doi.org/10.1007/BF01644125
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DOI: https://doi.org/10.1007/BF01644125