Caracterização clinica e imunologica de pacientes com imunodeficiencia comum variavel

AUTOR(ES)
DATA DE PUBLICAÇÃO

2001

RESUMO

Common variable immunodeticiency is an incompletely detined syndrome, characterized by a defect in antibody formation. Since CVI presents numerous, as yet unclarified, defects we proposed to analyze the evolution of the clínical-laboratorial presentations of 17 patients diagnosed with CVI from the Immunology-Allergy and Pneumology Clínic ofthe Hospital de Clínicas at the State University of Campinas, Brazil. The patients were evaluated according to their age at the initiation of symptoms and their clínical and immunological evolutional presentation. Blood monocyte phagocytic functions were evaluated in vitro by chemotaxis, phagocytosis mediated by Fc, CRI and CR3 and NADPH-oxidase activity. Concentrations of the serum levels of IgM, IgG, IgA and subclasses of IgG were determined by nephelometry and the lymphocyte subset and NK cells were evaluated by flow cytometry. All the patients presented initial clínical manifestations before four years of age, developing repeated infections and, in 8 patients, there was an association of gastrointestinal manifestations and 7 patients presented autoimmune phenomenons. At the time of diagnosis, the mean concentrations of IgM, IgG and IgA were 17.0 rng/dL, 365.0 mg/dL and 7.85 rng/dL, respectively. In CVI patients, significant reductions in all the subclasses of IgG (IgGI, p=0.0001;IgG2, p=0.002; IgG3, p=0.006 and IgG4, p=0.0001) were observed in relation to the control group. The elative number of NK cells was significantly reduced (p=0.006) whencompared with normal individuals. The percentage of CD3+ (p=0.013) and CD8+ T cells (p=0.004) were significant1yreduced in patients with CVI in relation to the control group. However a percentage of CD4+ T cells did not demonstrate any differences between the two groups. A reduction in the number of circulating B cells was also observed, with values lower than 2 % in 47 % of the patients with CVI. Phagocytosis measured via Fc, CRI, CR3 (p=0.0001) of monocytes and chemotaxis (p=0.0027) were significant1yreduced in the patients with CVI in relation to the normal controls. However, there was no difference in the superoxide production between the two groups. Due to the heterogeneity of the clinicalpresentations of our patients and those related by the literature, it may be suggested that CVI may be a phenotypic expression of various diseases and that the defects in the chemotaxis and phagocytosis of monocytes may be characterized in a group of patients, determining a new direction in the physiopathology of CVI

ASSUNTO(S)

monocitos quimiotaxia imunoglobulinas fagocitose

ACESSO AO ARTIGO

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