後天型低免疫球蛋白血症與嚴重感染於血液及腹膜透析之系統性紅斑狼瘡患者的相關性分析

Association Between Acquired Hypogammaglobulinemia and Serious Infections in Patients With Systemic Lupus Erythematosus Undergoing Maintenance Dialysis

目的：本研究旨在探討血液及腹膜透析之系統性紅斑狼瘡患者，後天型低免疫球蛋白血症是否與嚴重感染風險增加相關。此外，也將分析三種免疫球蛋白亞型（IgG、IgA、IgM）缺乏的分佈情形。
方法：本回溯性世代研究使用台北榮民總醫院121名末期腎疾病之系統性紅斑狼瘡患者資料。查找血清中三種免疫球蛋白的數值，根據標準參考值定義低免疫球蛋白血症，並記錄所有嚴重感染事件。使用Cox比例風險模型及Kaplan–Meier分析評估低免疫球蛋白血症與嚴重感染風險的關聯性。
結果：在接受規則透析的系統性紅斑狼瘡患者中，52.9%出現低免疫球蛋白血症，其中以IgM缺乏最常見（45.1%），其次為IgG（35.5%）和IgA（11.5%）。Cox回歸分析顯示，IgG（危險比[HR]: 1.14,95%信賴區間[CI]: 0.72－1.80, p = 0.556）、IgA（HR: 1.35, 95% CI: 0.66－2.72, p = 0.403）、IgM（HR:1.14, 95% CI: 0.73－1.81, p = 0.548）低下、合併兩種或三種免疫球蛋白亞型低下均非嚴重感染的顯著危險因子。Kaplan–Meier分析也一樣顯示，低免疫球蛋白血症與嚴重感染的發生無顯著相關性（logrankp > 0.05）。
結論：後天型低免疫球蛋白血症在血液及腹膜透析之系統性紅斑狼瘡患者中相當普遍，尤其是IgM數值低下。然而，後天型低免疫球蛋白血症與嚴重感染風險無關。

Objective: This study investigated whether acquired hypogammaglobulinemia is associated with an increased risk of serious infections in patients with systemic lupus erythematosus (SLE) undergoing maintenance dialysis. The study also analyzed the distribution of hypogammaglobulinemia among three immunoglobulin isotypes (IgG, IgA, and IgM) in these patients.
Methods: This retrospective study used data from 121 patients with SLE on dialysis at Taipei Veterans General Hospital. Serum immunoglobulin levels were retrieved, and hypogammaglobulinemia was defined based on standard reference ranges. Serious infection events were recorded. Risk factors, including types of hypogammaglobulinemia, were analyzed using Cox proportional hazards models and Kaplan-Meier survival analysis.
Results: Hypogammaglobulinemia was observed in 52.9% of patients with SLE on maintenance dialysis, with low IgM levels being the most prevalent (45.1%), followed by low IgG (35.5%) and IgA (11.5%). Cox regression analysis showed that low serum IgG (hazard ratio [HR]: 1.146, 95% confidence interval [CI]: 0.72－1.80, p = 0.556), IgA (HR: 1.35, 95% CI: 0.66－2.72, p = 0.403), IgM (HR: 1.14, 95% CI: 0.73－1.81, p = 0.548), and combined deficiencies involving two or three isotypes, were insignificant risk factors for serious infections. Kaplan-Meier analysis similiary showed no significant association between hypogammaglobulinemia and serious infections (all log-rank p > 0.05).