Symposia Report Immunoglobulin G for the Treatment of Chronic Pain:Report of an Expert Workshop

背景:慢性疼痛的治疗效果仍不理想.尽管现在治疗慢性疼痛的药物种类较多,但许多患者对疗效仍不满意或诉药物的副作用太大.越来越多的证据表明,免疫系统参与了伤害性和神经病理性慢性疼痛的病理过程.设计:在英国利物浦的专题会议上,专家们出示了免疫系统参与慢性疼痛的证据.近来的研究表明,静脉(IVIg)或皮下(SCIg)注射免疫调节药物——多价免疫球蛋白(IgG)可缓解外周神经病理性疼痛和其他疼痛性疾病.专题会议讨论了IVIg和SCIg治疗的适应证、效价比及其副作用.结果:IgG可缓解某些伤害性和神经病理性慢性疼痛,如糖尿病、干燥综合征、纤维肌痛症、复杂性区域疼痛综合征、小儿麻痹后遗症和继发于病理性自身抗体的疼痛.结论:IgG对某些慢性疼痛具有一定的治疗前景.IgG是一种相对安全的治疗方法,副作用少而轻,但价格较贵.今后有必要对IgG治疗顽固性疼痛进行随机对照研究和预测性临床试验.

北京地区人群中人Boca病毒血清抗体的分析

Objective To find out the importance of human bocavirus (HBoV) as an infectious agent for population in Beijing, China. Seroprevalence study was conducted by using expressed recombinant major capsid VP2 protein as an antigen.Methods Serum specimens collected from infants and children who visited the Children's Hospital Affiliated to the Capital Institute of Pediatrics for health check-up and adults visiting the Xuanwu Hospital, Beijing for diseases other than respiratory infections from April 1996 to March 1997 were used for the investigation. The major capsid protein VP2 from HBoV was expressed in E. coli strain BL21 (DE3) with the transformed PET30b vector inserted with full-length VP2 gene of HBoV and the specific antigenicity of this expressed protein was validated by previous study. Western blotting was used to detect specific IgG antibody against HBoV in collected serum specimens diluted to 1:200. Mock expressed protein was E. coli cells strain BL21 (DE3) with the transformed PET30b vector without insert. Anti-His monoclonal antibody and rabbit anti-HBoV VP2 polypeptides hyper-immune serum were used as positive control for antibody detection.Results Out of 677 serum specimens tested, 400 (59.1% ) were positive for HBoV by Western blotting. About 45.3% (34/75) of the newborns under 1 month of age had anti-HBoV antibodies, and antibody positive rates were decreased in age groups of 1 and 2 months (41.4% and 31.3%, respectively) then increased in the following ages from 6 months to 7 years old ( from 45.6% to 69.7% ). The antibody positive rates were maintained at a relatively constant level ( about 70% ) in the age groups from 7 years to 40 years of age and became lower ( 61.8% - 62. 8% ) in those over 50 years.Conclusions The high seroprevalence of antibody against recombinant HBoV VP2 protein and early age antibody acquisition indicate that HBoV has been circulating in population of Beijing, China as early as in 1996 and most of children had been exposed to HBoV by the age of 7 years. Infants under the age of 6 months were susceptible to this virus.

Objective To investigate the therapeutic potential of high-dase immunoglobulin (HIG) in experimental allergic neuritis (FAN) to provide a theoretical basis of its clinical use in the treatment of human inflammatory emyelinating neuropathies.Methods Female Lewis rats were induced to EAN,and divided into experimental and control groups. The rats were treated with either 0.3 g/kg.day-1 of IgG oran equivalent volume of 0.15 rnoVL glycine. Clinicst,electrophysiologic,and histologic evaluations were carried out in a blind fashion.Results Clinically, rars treated with fgG had significantly less severe symptoms (P＜0.001) and slower progression (P＜0.001) than controls.Electrophysiologically, the mean conduction latency of the experimental group was significantly shorter than controls (P＜0.05).Histologically,rats treated with lgG prepared from normal Lewis rats had a significantly lower percentage of damyelinated fibem (P=0.01)and total abnormal fibers (P＜0.001) than ontrels,Statistically,clinicat, electrophysiologic and moqrphologic data were all significantly correlated.Concluslons The EAN animal model is reliable for observation of HIG effects, and useful to provide data for clinical work. HIG has a significant therapeutic effect in EAN when given soon after disease onset. Itcan reduce clincal disease severity and decrease the number of demyelinated fibers as well as the number of total abnormal fibers. For the current corntroversy over whether HIG is effective, the results of this research support the clinical use of HIG in human damyelinating neuropathy.

Background: The comparative effectiveness of intravenous immunoglobulin (IVIG) for Kawasaki disease was regarded as inconclusive in the international guidelines. However, several new evidences have been published in recent years.
Data sources: A literature search of PubMed was conducted using key words of "Kawasaki disease or mucocutaneous lymph node syndrome" and "immunoglobulin" in combination. Only original articles published after 2004 were selected. A total of 813 papers were found in PubMed. These papers were screened manually by their titles and abstracts.
Results: Patients treated with IVIG prepared by betapropiolactonation might have worse outcome (a higher non-responsive rate in one report and a higher rate of coronary aneurysm in two reports). Storage of IVIG in acidic solution might be correlated with a higher rate of coronary aneurysm (two reports).
Conclusions: Different processes of preparation and conditions of preservation of IVIG may have profound effects on its clinical effectiveness. Randomized controlled studies are needed to further elucidate this issue.