{"id":76095,"date":"2024-03-04T06:31:16","date_gmt":"2024-03-04T08:31:16","guid":{"rendered":"https:\/\/www.pasveik.lt\/?p=76095\/sveikatos-ir-medicinos-naujienos"},"modified":"2024-03-04T06:31:19","modified_gmt":"2024-03-04T08:31:19","slug":"klinikine-bendrojo-imunoglobulino-e-reiksme","status":"publish","type":"post","link":"https:\/\/www.pasveik.lt\/lt\/naujausi-medicinos-straipsniai\/klinikine-bendrojo-imunoglobulino-e-reiksme\/76095\/","title":{"rendered":"<strong>Klinikin\u0117 bendrojo imunoglobulino E reik\u0161m\u0117<\/strong>"},"content":{"rendered":"\n<p>Imunoglobulinai&nbsp;E (IgE) sudaro tik 0,002&nbsp;proc. viso \u017emogaus Ig kiekio, ta\u010diau \u0161ie antik\u016bnai stipriausiai i\u0161 vis\u0173 jungiasi su antigenais ir savo receptoriais&nbsp;[1]. Nedidelis kiekis aktyvint\u0173 IgE molekuli\u0173 imunini\u0173 l\u0105steli\u0173 pavir\u0161iuje gali sukelti labai stiprias ir net gyvybei pavojingas reakcijas. IgE atradimas 1968 metais reik\u0161mingai pakeit\u0117 alergini\u0173 lig\u0173 patogenez\u0117s supratim\u0105 ir diagnostik\u0105&nbsp;[2], o gydymas biologine terapija monokloniniais antik\u016bnais nukreiptais prie\u0161 IgE pagilino \u0161ias \u017einias&nbsp;[3]. \u0160iuo metu i\u0161 laboratorini\u0173 alergini\u0173 tyrim\u0173 klinikin\u0117je praktikoje populiariausi yra specifini\u0173 konkretiems alergenams ar j\u0173 komponentams IgE nustatymas fluoroimunofermentiniais (<em>ImmunoCAP<\/em>), radioimuniniais (RAST) [4] ir molekuliniais tyrimais [5]. Straipsnyje aptarsime bendrojo IgE (bIgE) nustatymo vert\u0119 ir galimas jo padid\u0117jimo prie\u017eastis.<\/p>\n\n\n\n<p><strong>IgE<\/strong><\/p>\n\n\n\n<p>Vis\u0173 antigenui specifini\u0173 imunoglobulin\u0173 gamybai aktyvinti reikalinga B limfocit\u0173 stimuliacija antigenu. B limfocitai tampa plazmin\u0117mis l\u0105stel\u0117mis ir gamina IgE izotipo antik\u016bnus, paveikti Il-4, Il-13 ir T limfocit\u0173 [4]. \u012edomu, kad \u017emogaus organizme randama ir vadinam\u0173j\u0173 nat\u016brali\u0173 IgE, kuri\u0173 gamyba nepriklauso nuo T limfocit\u0173 ir antigenin\u0117s stimuliacijos. Nors j\u0173 funkcija n\u0117ra \u017einoma, manoma, kad jie veikia autoantigenus\u00a0[6].<\/p>\n\n\n\n<p>IgE gaminan\u010dios plazmin\u0117s l\u0105stel\u0117s randamos vir\u0161kinimo trakto ir kv\u0117pavimo tak\u0173 gleivini\u0173 limfinio audinio sankaupose, daugiausiai j\u0173 yra tonzil\u0117se ir adenoiduose. Kaip ir kiti imunoglobulinai, IgE yra sudaryti i\u0161 2 lengv\u0173j\u0173 ir 2 sunki\u0173j\u0173 grand\u017ei\u0173. Pastarosios turi 4 pastoviuosius domenus (C\u03b51-C\u03b54). Daugelis IgE molekuli\u0173 yra prisijung\u0119 prie putli\u0173j\u0173 l\u0105steli\u0173 ir bazofil\u0173 per Fc\u03b5RI receptorius, ma\u017eesn\u0117 dalis&nbsp;\u2013 prie B limfocit\u0173 ir kv\u0117pavimo tak\u0173 lygi\u0173j\u0173 raumen\u0173 l\u0105steli\u0173 per Fc\u03b5RII receptorius [7].<\/p>\n\n\n\n<p>IgE kiekis kraujo serume matuojamas nanogramais (ng) arba tarptautiniais vienetais (TV\/ml, IU\/ml ar kIU\/l). 1&nbsp;IU sudaro 2,4&nbsp;ng baltymo. Manoma, kad IgE molekul\u0117s motinos vaisiui per placent\u0105 neperduodamos, ta\u010diau yra duomen\u0173, kad vaisius alergenui specifinius IgE gali pagaminti jau nuo 11 gestacin\u0117s savait\u0117s [8, 9]. Nuo gimimo IgE kiekis kraujyje did\u0117ja iki 10\u201315 met\u0173, o v\u0117liau palaipsniui ma\u017e\u0117ja [10, 11]. Didesnis bIgE nustatomas vyrams, afroamerikie\u010diams, nutukusiems ir r\u016bkantiems asmenims [12]. Atopin\u0117mis ligomis sergan\u010di\u0173j\u0173 bIgE kiekis gali kisti d\u0117l kontakto su alergenais, pavyzd\u017eiui, sergantiems sezoniniu alerginiu rinitu pacientams bIgE kiekis yra did\u017eiausias po \u017eyd\u0117jimo pra\u0117jus 4\u20136 savait\u0117ms sezono, o v\u0117liau palaipsniui ma\u017e\u0117ja [7]. I\u0161skiriamos 4 pagrindin\u0117s prie\u017eastys, d\u0117l kuri\u0173 gali padid\u0117ti bIgE koncentracija kraujyje:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>d\u0117l nespecifinio baltym\u0173 gamybos ir katabolizmo sutrikimo;<\/li>\n\n\n\n<li>d\u0117l sutrikusios imunin\u0117s sistemos pusiausvyros ir reguliacijos;<\/li>\n\n\n\n<li>d\u0117l lig\u0173, kada padid\u0117ja IgE sintez\u0117;<\/li>\n\n\n\n<li>d\u0117l alergenui specifini\u0173 IgE sintez\u0117s.<\/li>\n<\/ul>\n\n\n\n<p>Ligos, kuriomis sergant nustatomos ypa\u010d didel\u0117s bIgE koncentracijos, nurodytos <em>1\u00a0lentel\u0117je<\/em>.<\/p>\n\n\n\n<p><strong>1 lentel\u0117. Ligos, kuriomis sergant nustatomos ypa\u010d didel\u0117s bIgE (\u2265500&nbsp;IU\/ml) koncentracijos<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td>Alergin\u0117 bronchopulmonin\u0117 mikoz\u0117<\/td><\/tr><tr><td>Alerginis grybelinis sinusitas<\/td><\/tr><tr><td>Atopinis dermatitas<\/td><\/tr><tr><td>\u017dmogaus imunodeficito viruso sukelta infekcija<\/td><\/tr><tr><td>Hiperimunoglobulinemija E (padid\u0117jusio IgE sindromas)<\/td><\/tr><tr><td>Imunoglobulino E mieloma<\/td><\/tr><tr><td>Kimura liga<\/td><\/tr><tr><td>Limfoma<\/td><\/tr><tr><td>Nethertono sindromas<\/td><\/tr><tr><td>Sistemin\u0117 helmint\u0173 infekcija<\/td><\/tr><tr><td>Tuberkulioz\u0117<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Imunoglobulinas E ir alergin\u0117s ligos\u00a0\u00a0<\/strong><\/p>\n\n\n\n<p>Nusta\u010dius padid\u0117jusi\u0105 bIgE koncentracij\u0105 kraujo serume, did\u0117ja tikimyb\u0117, kad bus teigiamas alergenams specifini\u0173 IgE tyrimas. Didel\u0117s apimties suaugusi\u0173j\u0173 tyrime nustatyta, kad tiriamieji, kuri\u0173 kraujo bIgE koncentracija buvo didesn\u0117 nei 66&nbsp;IU\/ml, 37 kartus da\u017eniau buvo \u012fsijautrin\u0119 vienam ar keliems alergenams [13]. Nors bIgE rodiklis da\u017enai naudojamas kaip atrankinis alergini\u0173 lig\u0173 diagnostikai, tuo po\u017ei\u016briu jo vert\u0117 yra ribota. Witting su bendraautoriais \u012fvertino bIgE tyrimo jautrum\u0105 ir specifi\u0161kum\u0105 sergant skirtingomis alergin\u0117mis ligomis. Jei rodiklis didelis (&gt;320&nbsp;IU\/ml), tyrimo specifi\u0161kumas siekia 98&nbsp;proc., ta\u010diau jautrumas yra ma\u017eas (59\u201323&nbsp;proc.). Suma\u017einus rodiklio norm\u0105, tyrimo jautrumas pager\u0117ja, ta\u010diau ma\u017e\u0117ja specifi\u0161kumas. Tyr\u0117j\u0173 duomenys pateikiami <em>2&nbsp;lentel\u0117je<\/em> [14].<\/p>\n\n\n\n<p><strong>2 lentel\u0117. BIgE tyrimo jautrumas ir specifi\u0161kumas<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td><strong>Liga<\/strong><\/td><td><strong>Vir\u0161utin\u0117s normos riba (IU\/ml)<\/strong><\/td><td><strong>Jautrumas (proc.)<\/strong><\/td><td><strong>Specifi\u0161kumas (proc.)<\/strong><\/td><\/tr><tr><td><strong>&nbsp;<\/strong><\/td><\/tr><tr><td>Astma<\/td><td>80<\/td><td>82<\/td><td>73<\/td><\/tr><tr><td>&nbsp;<\/td><td>320<\/td><td>55<\/td><td>98<\/td><\/tr><tr><td>&nbsp;<\/td><td>100<\/td><td>78<\/td><td>80<\/td><\/tr><tr><td>Alerginis rinitas<\/td><td>80<\/td><td>72<\/td><td>73<\/td><\/tr><tr><td>&nbsp;<\/td><td>320<\/td><td>30<\/td><td>98<\/td><\/tr><tr><td>&nbsp;<\/td><td>100<\/td><td>60<\/td><td>80<\/td><\/tr><tr><td>Egzema<\/td><td>80<\/td><td>75<\/td><td>73<\/td><\/tr><tr><td>&nbsp;<\/td><td>320<\/td><td>59<\/td><td>98<\/td><\/tr><tr><td>&nbsp;<\/td><td>100<\/td><td>70<\/td><td>80<\/td><\/tr><tr><td>Dilg\u0117lin\u0117<\/td><td>80<\/td><td>68<\/td><td>73<\/td><\/tr><tr><td>&nbsp;<\/td><td>320<\/td><td>23<\/td><td>98<\/td><\/tr><tr><td>&nbsp;<\/td><td>100<\/td><td>ND<\/td><td>80<\/td><\/tr><\/tbody><\/table><figcaption class=\"wp-element-caption\"><em>ND \u2013 n\u0117ra duomen\u0173.<\/em><\/figcaption><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p>Marsh ir bendraautori\u0173 skai\u010diavimu, optimali bIgE riba, atskirianti alergi\u0161kus ir nealergi\u0161kus suaugusius tiriamuosius, yra 100\u00a0IU\/ml, ta\u010diau taikant \u0161i\u0105 normos rib\u0105 apie 20\u00a0proc. atvej\u0173 yra klaidingai klasifikuojami kaip teigiami ar neigiami [15]. Praktikoje vertinant bIgE koncentracij\u0105, svarbu atsi\u017evelgti \u012f tiriamojo am\u017ei\u0173, nes normos skiriasi (<em>3\u00a0lentel\u0117<\/em>) [16].<\/p>\n\n\n\n<p><strong>3 lentel\u0117. BIgE normos pagal am\u017ei\u0173<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td><strong>Am\u017eius<\/strong><\/td><td><strong>Norma (IU\/ml)<\/strong><\/td><\/tr><tr><td>Naujagimiai<\/td><td>0\u20131,5<\/td><\/tr><tr><td>1\u201312 m\u0117nesi\u0173<\/td><td>0\u201315<\/td><\/tr><tr><td>2\u20135 met\u0173<\/td><td>0\u201360<\/td><\/tr><tr><td>6\u20139 met\u0173<\/td><td>0\u201390<\/td><\/tr><tr><td>10\u201315 met\u0173<\/td><td>0\u2013200<\/td><\/tr><tr><td>Suaugusieji<\/td><td>0\u2013100<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p>Net nustatin\u0117jant ne bIgE, o atliekant alergenui specifinius IgE, teigiamas tyrimo rezultatas tur\u0117t\u0173 b\u016bti vertinamas kriti\u0161kai. Ne visada alergenui specifini\u0173 IgE tyrimu patvirtinta sensibilizacija alergenams pasirei\u0161kia klini\u0161kai. Tyrimo rezultatas vertinamas kaip reik\u0161mingas, jei j\u012f galime susieti su tiriamojo paciento ligos simptomais [17]. Praktikoje bIgE tyrimas vertingiausias tuo, kad nustatant labai ma\u017eas vertes patikimai galima paneigti I tipo padid\u0117jusio jautrumo reakcijas, jeigu kartu n\u0117ra joms b\u016bding\u0173 simptom\u0173.<\/p>\n\n\n\n<p>Toliau aptarsime nealergines ligas, kuriomis sergant nustatomos ne\u012fprastai didel\u0117s bIgE koncentracijos (<em>4&nbsp;lentel\u0117<\/em>).<\/p>\n\n\n\n<p><strong>4 lentel\u0117. Nealergin\u0117s ligos ir b\u016bkl\u0117s, kuriomis sergant nustatomas padid\u0117jusi bIgE koncentracija (\u2265500\u202fIU\/ml)<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table><tbody><tr><td>Parazitoz\u0117s<\/td><td>Askaridoz\u0117 <br>Visceralin\u0117 migruojan\u010dioji lerva <br>Kapiliariaz\u0117 <br>Paragonimoz\u0117 <br>Fasciolioz\u0117 <br>\u0160istosomoz\u0117 <br>Ankilostomiaz\u0117 <br>Trichinelioz\u0117 <br>Filarioz\u0117 <br>Strongiloidoz\u0117 <br>Echinokokoz\u0117 <br>Onchocerkiaz\u0117 <br>Maliarija<\/td><\/tr><tr><td>Infekcijos<\/td><td>Sistemin\u0117 kandidoz\u0117 <br>Kokcidioidomikoz\u0117 <br>Raupsai <br>Epsteino-Barr arba citomegalo virus\u0173 sukelta mononukleoz\u0117 <br>Virusin\u0117s kv\u0117pavimo tak\u0173 infekcijos <br>\u017dmogaus imunodeficito viruso sukelta liga <br>Kokliu\u0161as<\/td><\/tr><tr><td>Odos ligos<\/td><td>\u017didininis nuplikimas <br>Buliozinis (p\u016bslinis) pemfigoidas <br>L\u0117tinis akrodermatitas <br>Streptokok\u0173 sukelta mazgin\u0117 raudon\u0117<\/td><\/tr><tr><td>Kitos ligos ir b\u016bkl\u0117s<\/td><td>Alergin\u0117 bronchopulmonin\u0117 mikoz\u0117 <br>Nefrozinis sindromas <br>Vaist\u0173 sukeltas intersticinis nefritas <br>Kepen\u0173 ligos <br>Cistin\u0117 fibroz\u0117 <br>Kavasaki liga <br>Jaunatvinis mazginis poliarteritas <br>Pirmin\u0117 plau\u010di\u0173 hemosideroz\u0117 <br>Guillaino-Barre\u02bco sindromas <br>Nudegimai <br>Reumatoidinis artritas <br>Kaul\u0173 \u010diulp\u0173 transplantacija <br>R\u016bkymas <br>Alkoholizmas<\/td><\/tr><tr><td>Onkologin\u0117s ligos<\/td><td>Hodgkino limfoma <br>Imunoglobulino E mieloma <br>Bronch\u0173 karcinoma<\/td><\/tr><tr><td>Imunodeficitai<\/td><td>Wiskotto-Aldricho sindromas <br>Hiperimunoglobulinemija E (padid\u0117jusio IgE sindromas) <br>Di George\u02bco sindromas <br>Nezelofo sindromas <br>Izoliuota imunoglobulino A stoka<\/td><\/tr><tr><td>Vaistai<\/td><td>Enfuvirtidas <br>Folkodinas<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Imunoglobulinas E ir infekcin\u0117s ligos<\/strong><\/p>\n\n\n\n<p><strong>Virusin\u0117s infekcijos.<\/strong> Welliver su bendraautoriais pirmieji nustat\u0117, kad vaikams, sergantiems respiracinio sincitinio viruso (RSV) sukeltu bronchiolitu, gali susidaryti \u0161iam virusui specifiniai IgE, o j\u0173 nustatymas yra susij\u0119s didesne \u0161vok\u0161timo rizika tiek \u016bmios infekcijos metu, tiek per 4 tolesnius vaiko b\u016bkl\u0117s steb\u0117jimo metus [18]. V\u0117liau atliktuose tyrimuose buvo randama virusams specifini\u0173 IgE antik\u016bn\u0173 prie\u0161 \u017dIV-1, parvo B19, paragripo, juostin\u0117s p\u016bslelin\u0117s virusus. Atlikti tyrimai d\u0117l virusui specifini\u0173 IgE susidarymo po skiepijimo nuo gripo ir kokliu\u0161o, difterijos, stablig\u0117s (DTaP). Kai kuri\u0173 tiriam\u0173j\u0173 kraujyje buvo rasta ne tik IgG, bet ir IgE antik\u016bn\u0173, ta\u010diau j\u0173 reik\u0161m\u0117 vakcin\u0173 efektyvumui ir tinkamumui n\u0117ra \u017einoma [19, 20]. Skirting\u0173 tyr\u0117j\u0173 duomenimis, laikinai bIgE rodiklis padid\u0117ja sergant Epsteino-Barr, tym\u0173, rinovirus\u0173 sukeltomis infekcijomis [21]. \u012edomu, kad u\u017esikr\u0117tusiesiems \u017dIV da\u017eniau nustatomas padid\u0117j\u0119s bIgE rodiklis, o sergantiesiems AIDS (\u012fgytasis imunodeficito sindromas) da\u017enai pasirei\u0161kia alergin\u0117s reakcijos \u012f aplinkos alergenus ir vaistus [22].<\/p>\n\n\n\n<p><strong>Bakterin\u0117s infekcijos.<\/strong> Manoma, kad IgE n\u0117ra svarbus imunin\u0117s sistemos atsakui \u012f bakterijas, nes neaktyvina komplemento ir nedalyvauja opsonizacijoje. Vis d\u0117lto sergan\u010di\u0173j\u0173 alerginiu rinitu, bronch\u0173 astma, atopiniu dermatitu kraujyje randama IgE antik\u016bn\u0173 prie\u0161 stafilokok\u0173 enterotoksinus A ir&nbsp;\/&nbsp;ar B, o sergan\u010di\u0173j\u0173 hiperimunoglobulinemija E&nbsp;\u2013 prie\u0161 auksinio stafilokoko egzotoksinus [23]. N\u0117ra ai\u0161ki \u0161i\u0173 radini\u0173 reik\u0161m\u0117.<\/p>\n\n\n\n<p><strong>Mieliagrybi\u0173 ir grybelin\u0117s infekcijos.<\/strong> Sergan\u010di\u0173 atopiniu dermatitu pacient\u0173 kraujyje nustatomi IgE specifiniai baltajam balk\u0161vagrybiui (<em>Candida albicans<\/em>)<em>.<\/em> \u012esijautrinimas <em>Pityrosporum ovale<\/em> (<em>s<\/em>.&nbsp;<em>Malassezia furfur<\/em>) grybeliui gali sukelti galvos, veido ir kaklo dermatit\u0105. Gydant dermatofito <em>Trichophyton<\/em> sukelt\u0105 odos infekcij\u0105, pager\u0117ja \u0161iam grybeliui sensibilizuot\u0173 astma sergan\u010di\u0173 pacient\u0173 kv\u0117pavimo tak\u0173 simptom\u0173 kontrol\u0117 [24, 25].<\/p>\n\n\n\n<p><strong>Parazitoz\u0117s.<\/strong> Sergant helmint\u0173 sukeliamomis infekcijomis, bIgE koncentracija did\u0117ja d\u0117l parazitui specifini\u0173 ir nespecifini\u0173 poliklonini\u0173 IgE gamybos. BIgE koncentracija kraujyje priklauso nuo invazijos intensyvumo, o po s\u0117kmingo gydymo bIgE ma\u017e\u0117ja [26, 27]. Deja, n\u0117ra bendros nuomon\u0117s, ar susidar\u0119 IgE apsaugo \u017emog\u0173 nuo susirgimo pakartotinio kontakto su infekcijos suk\u0117l\u0117ju metu [28]. Lynch su bendraautoriais vietov\u0117se, kur paplitusios trichiuroz\u0117 ir askaridoz\u0117, palygino d\u0117l helmintoz\u0117s gydomus ir negydomus vaikus. Nors gydyt\u0173 vaik\u0173 kraujyje buvo ma\u017eesni IL-4, bIgE ir eozinofilijos rodikliai, jie statisti\u0161kai reik\u0161mingai da\u017eniau buvo \u012fsijautrin\u0119 nam\u0173 dulki\u0173 erki\u0173 alergenams (17\u00a0proc. <em>vs<\/em>. 68\u00a0proc., p&lt;0,001) [29].<\/p>\n\n\n\n<p><strong>Kitos prie\u017eastys, lemian\u010dios bIgE padid\u0117jim\u0105<\/strong><\/p>\n\n\n\n<p><strong>Onkologin\u0117s ligos.<\/strong> Padid\u0117jusi bIgE koncentracija nustatoma ir sergantiesiems kai kuriomis onkologin\u0117mis ligomis (<em>4&nbsp;lentel\u0117<\/em>). Tik imunoglobulino E mieloma turi ai\u0161k\u0173 ry\u0161\u012f tarp ligos patogenez\u0117s ir bIgE padid\u0117jimo. Nuo 1967 met\u0173 apra\u0161yta apie 40 \u0161ios ligos atvej\u0173. IgE mielomos simptomai yra tokie patys kaip kit\u0173 mielomini\u0173 lig\u0173, ta\u010diau sergan\u010di\u0173j\u0173 i\u0161gyvenamumas trumpesnis. BIgE koncentracijos naujai diagnozuotiems ligoniams svyruoja nuo 0,6 iki 63&nbsp;g\/l [30].<\/p>\n\n\n\n<p>Epidemiologini\u0173 tyrim\u0173, vertinan\u010di\u0173 alergini\u0173 ir onkologini\u0173 lig\u0173 ry\u0161\u012f, duomenys prie\u0161taringi. Sergantieji astma turi didesn\u0119 rizik\u0105 sirgti bronch\u0173 karcinoma, prostatos ir \u0161lapimo p\u016bsl\u0117s v\u0117\u017eiu. Manoma, kad tai lemia l\u0117tinis u\u017edegiminis procesas. Tiesa, jei \u012f tyrim\u0105 \u012ftraukiami tik ner\u016bkantys asmenys, ry\u0161ys silpn\u0117ja. Kita vertus, sergantys alergin\u0117mis ligomis pacientai turi ma\u017eesn\u0119 rizik\u0105 sirgti kasos, smegen\u0173, kraujo, storosios \u017earnos, skrand\u017eio ir ginekologin\u0117mis onkologin\u0117mis ligomis [31]. IgE antik\u016bnai atpa\u017e\u012fsta nepa\u017eeistos konformacijos, epitop\u0173 gausius antigenus. Tokiomis savyb\u0117mis pasi\u017eymi v\u0117\u017eini\u0173 l\u0105steli\u0173 antigenai, tod\u0117l daroma prielaida, kad IgE \u012f auglio audin\u012f pritraukia efektorines l\u0105steles, turin\u010dias tumorocidin\u012f poveik\u012f ir saugo organizm\u0105 nuo onkologini\u0173 lig\u0173. Tikimasi \u0161ias galimai antiv\u0117\u017eines IgE savybes ateityje pritaikyti gydant onkologines ligas [32].<\/p>\n\n\n\n<p>Vertinant vien bIgE koncentracij\u0105 serume ir bendr\u0105j\u012f onkologini\u0173 lig\u0173 da\u017en\u012f, koreliacijos nenustatyta nei kohortiniame 70&nbsp;t\u016bkst. pacient\u0173 tyrime (standartizuotas sergamumo santykis 107, 95&nbsp;proc. PI 82\u2013137), nei 25&nbsp;t\u016bkst. sveik\u0173 asmen\u0173 11 met\u0173 stebimajame tyrime (did\u017eiausio ir ma\u017eiausio kvartilio rizikos santykis 0,90, 95&nbsp;proc. PI 0,74\u20131,10) [33, 34].<\/p>\n\n\n\n<p><strong>Transplantacija.<\/strong> Po kaul\u0173 \u010diulp\u0173 transplantacijos bIgE koncentracija gali padid\u0117ti nuo 7 iki 2&nbsp;t\u016bkst. kart\u0173. Anks\u010diau manyta, kad tokie poky\u010diai galimi d\u0117l transplantato prie\u0161 \u0161eiminink\u0105 ligos, ta\u010diau v\u0117liau tai buvo paneigta ir \u0161iuo metu prie\u017eastis n\u0117ra \u017einoma. Literat\u016broje apra\u0161omi naujai i\u0161sivys\u010diusios alergijos po organ\u0173 transplantacijos (pvz., inkst\u0173, kepen\u0173, plau\u010di\u0173) atvejai [35\u201337].<\/p>\n\n\n\n<p><strong>Inkst\u0173 ir kepen\u0173 ligos.<\/strong> BIgE padid\u0117ja ligoniams, sergantiems inkst\u0173 ligomis&nbsp;\u2013 minimali\u0173 pakitim\u0173 liga, IgM nefropatija, membraniniu glomerulonefritu, \u017eidinine glomeruloskleroze ir kitais glomerulonefritais pasirei\u0161kian\u010diu nefroziniu sindromu. Tinkamai gydant pagrindin\u0119 inkst\u0173 lig\u0105, bIgE rodiklis suma\u017e\u0117ja. Toki\u0173 poky\u010di\u0173 prie\u017eastys n\u0117ra \u017einomos [38]. Pacientams, sergantiems kepen\u0173 ligomis, taip pat nustatoma padid\u0117jusi bIgE koncentracija. Da\u017eniau tokie poky\u010diai nustatomi sergantiems kepen\u0173 ciroze, sukelta alkoholio vartojimo, nei d\u0117l kit\u0173 prie\u017eas\u010di\u0173, toki\u0173 kaip virusiniai B ar C hepatitai [30].<\/p>\n\n\n\n<p><strong>R\u016bkymas.<\/strong> BIgE koncentracijos padid\u0117jimas yra susij\u0119s su r\u016bkymu. Buvusiems r\u016bkaliams kraujo rodikliai pager\u0117ja, ta\u010diau negr\u012fsta iki normali\u0173. Didesni poky\u010diai nustatomi r\u016bkaliams vyrams nei moterims [13, 39].<\/p>\n\n\n\n<p><strong>Naujov\u0117s praktikoje pritaikant bIgE tyrim\u0105<\/strong><\/p>\n\n\n\n<p>Lietuvoje atsiradus galimybei alergini\u0173 lig\u0173 gydymui skirti kompensuojamuosius biologinius vaistus, bIgE tyrimas tapo svarbus naujais aspektais. Sergantiesiems sunkia alergine ar eozinofiline astma kaip papildomas gydymas gali b\u016bti skiriami anti-IgE, anti-IL5, anti-IL5R\u03b1 monokloniniai antik\u016bnai. Naujieji vaistai skiriami \u012fvertinus paciento b\u016bkl\u0117s sunkum\u0105, skirto gydymo efektyvum\u0105 ir astmos fenotip\u0105. Anti-IgE preparatai gali b\u016bti skiriami tik tiems pacientams, kuriems nustatytas teigiamas odos testas ar <em>i<\/em><em>n vitro<\/em> reaktyvumas nesezoniniams \u012fkvepiamiesiems alergenams. Jei pacientas atitinka Lietuvos Respublikos sveikatos apsaugos ministerijos kompensuojam\u0173j\u0173 vaist\u0173 skyrimo tvarkoje nurodytus kriterijus, vaisto doz\u0117 ir vartojimo da\u017enis parenkami pagal paciento svor\u012f ir bIgE rodikl\u012f. Pagal preparato charakteristik\u0173 santrauk\u0105, pacientams, kuri\u0173 bIgE koncentracija ma\u017eesn\u0117 nei 76&nbsp;IU\/ml, klinikin\u0117 nauda gaunama re\u010diau, esant didesnei nei &gt;1&nbsp;500&nbsp;IU\/ml bIgE koncentracijai, vaisto vartoti negalima. [40, 41]<\/p>\n\n\n\n<p>Pacientams, sergantiems l\u0117tine sunkia spontanine dilg\u0117line, anti-IgE preparatai skiriami kaip tre\u010dios eil\u0117s gydymas, kai gydymas \u012fprastin\u0117mis ir keturgubomis antihistaminini\u0173 vaist\u0173 doz\u0117mis n\u0117ra labai efektyvus [42]. Skirtingai nei sergant astma, pradin\u0117 vaisto doz\u0117 nepriklauso nuo bIgE rodiklio, ta\u010diau, naujausi\u0173 tyrim\u0173 duomenimis, bIgE rodiklis gal\u0117t\u0173 b\u016bti naudojamas kaip prognostinis \u017eymuo gydymo efektyvumui nusp\u0117ti. Esant ma\u017eai bIgE koncentracijai (&lt;43&nbsp;IU\/ml), 33&nbsp;proc. atvej\u0173 per pirm\u0105sias 12 savai\u010di\u0173 gydymo teigiamo atsako \u012f gydym\u0105 n\u0117ra. Esant didesnei nei 43 IU\/ml bIgE koncentracijai, nes\u0117kmingo gydymo atvej\u0173 skai\u010dius&nbsp;\u2013 tik 5&nbsp;proc. Kitas si\u016blomas b\u016bdas gydymo efektyvumui nusp\u0117ti yra bIgE koncentracijos \u012fvertinimas po 4 gydymo savai\u010di\u0173&nbsp;\u2013 gydymo efekto galime tik\u0117tis pacientams, kuriems per pirm\u0105sias 4 savaites bIgE serume padid\u0117ja dvigubai ar daugiau [43].<\/p>\n\n\n\n<p><strong>Apibendrinimas<\/strong><\/p>\n\n\n\n<p>Da\u017eniausiai IgE yra siejami su alergin\u0117mis ligomis, ta\u010diau imuninei sistemai jie svarb\u016bs ir d\u0117l kit\u0173 kol kas ne iki galo ai\u0161ki\u0173 funkcij\u0173. Nors bIgE padid\u0117jimas da\u017enai leid\u017eia \u012ftarti alergin\u0119 lig\u0105, tai n\u0117ra pakankamai jautrus ir specifi\u0161kas tyrimas diagnozei patvirtinti ar paneigti. BIgE koncentracija gali b\u016bti padid\u0117jusi ir sergant infekcin\u0117mis, onkologin\u0117mis ar kitomis ligomis. Padid\u0117jimo prie\u017eastis neretai lieka neai\u0161ki. \u0160iuo metu da\u017eniausiai gydytojo alergologo praktikoje \u0161is tyrimas naudojamas vertinant d\u0117l alergini\u0173 lig\u0173 gydymo biologine terapija indikacij\u0173, parenkant vaisto dozes. Ateityje tai gal\u0117t\u0173 b\u016bti bio\u017eymuo l\u0117tin\u0117s dilg\u0117lin\u0117s gydymo efektyvumui biologine terapija nusp\u0117ti.<\/p>\n\n\n\n<p><strong>Gyd. R\u016bta V\u0117brien\u0117, prof. Laura Malinauskien\u0117<\/strong> <br>Vilniaus universiteto Medicinos fakulteto Klinikin\u0117s medicinos instituto Kr\u016btin\u0117s lig\u0173, imunologijos ir alergologijos klinika<\/p>\n\n\n\n<p><strong>LITERAT\u016aRA<\/strong><\/p>\n\n\n\n<p>1. Hamilton RG, Adkinson FN. In vitro assays for the diagnosis of IgE-mediated disorders. J Allergy Clin Immunol. 2004;114:213-225.<br>2. Bennich HH, et al. Immunoglobulin E: a new class of human immunoglobulin. Immunology. 1968;15:323-324.<br>3. Okayama Y, et al. Roles of omalizumab in various allergic diseases. Allergol Int. 2020. doi: 10.1016\/j.alit.2020.01.004.<br>4. Kelly BT, Grayson MH. Immunoglobulin E, what is it good for? Ann Allergy Asthma Immunol. 2016; 116: 183-187.<br>5. Ansotegui IJ, et al. A WAO &#8211; ARIA &#8211; GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J. 2020; 13: 100091.<br>6. McCoy KD, et al. Natural IgE production in the absence of MHC Class II cognate help. Immunity. 2006;24:329-339.<br>7. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. 2010;125:73-80.<br>8. Bertino E, et al. Relationship between maternal- and fetal-specific IgE. Pediatr Allergy Immunol. 2006;17:484-488.<br>9. Lima JO, et al. Early expression of iepsilon, CD23 (FcepsilonRII), IL-4Ralpha, and IgE in the human fetus. J Allergy Clin Immunol. 2000;106:911-917.<br>10. Barbee RA, et al. Distribution of IgE in a community population sample: correlations with age, sex, and allergen skin test reactivity. J Allergy Clin Immunol. 1981; 68: 106-111.<br>11. Lindberg RE, Arroyave C. Levels of IgE in serum from normal children and allergic children as measured by an enzyme immunoassay. J Allergy Clin Immunol. 1986; 78: 614-618.<br>12. Gergen PJ, et al. Total IgE levels and asthma prevalence in the US population: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2009; 124: 447-453.<br>13. Omenaas E, et al. Total and specific serum IgE levels in adults: relationship to sex, age and environmental factors. Clin Exp Allergy. 1994; 24: 530-539.<br>14. Wittig HJ, et al. Age-related serum immunoglobulin E levels in healthy subjects and in patients with allergic disease. J Allergy Clin Immunol. 1980; 66: 305-313.<br>15. Marsh DG, <a>et al. <\/a>Genetic control of basal serum immunoglobulin E level and its effect on specific reaginic sensitivity. Proc Natl Acad Sci U S A. 1974; 71: 3588-3592.<br>16. Zaleskis G. Pagrindini\u0173 laboratorini\u0173 tyrim\u0173 \u017einynas. Vilnius: Vaist\u0173 \u017einios 2002, 548 p.<br>17. Bousquet J, et al. Factors responsible for differences between asymptomatic subjects and patients presenting an IgE sensitization to allergens. Allergy. 2006; 61: 671-680.<br>18. Welliver RC, Sun M, Rinaldo D, Ogra PL. Predictive value of respiratory syncytial virus-specific IgE responses for recurrent wheezing following bronchiolitis. J Pediatr. 1986; 109: 776-780.<br>19. Smith-Norowitz TA, et al. Long term persistence of IgE anti-influenza virus antibodies in pediatric and adult serum post vaccination with influenza virus vaccine. Int J Med Sci. 2011; 8: 239-244.<br>20. Holt PG, et al. Transiently increased IgE responses in infants and pre-schoolers receiving only acellular Diphtheria-Pertussis-Tetanus (DTaP) vaccines compared to those initially receiving at least one dose of cellular vaccine (DTwP) &#8211; Immunological curiosity or canary in the mine? Vaccine. 2016; 34: 4257-4262.<br>21. Skoner DP, et al. Effect of rhinovirus 39 (RV-39) infection on immune and inflammatory parameters in allergic and non-allergic subjects. Clin Exp Allergy. 1995; 25: 561-567.<br>22. Miguez-Burbano MJ, et al. Immunoglobulin E levels in relationship to HIV-1 disease, route of infection, and vitamin E status. Allergy. 1995; 50: 157-161.<br>23. Lee JH, et al. Increased levels of serum-specific immunoglobulin e to staphylococcal enterotoxin a and B in patients with allergic rhinitis and bronchial asthma. Int Arch Allergy Immunol. 2005; 138: 305-311.<br>24. Ito K, et al. Characterization of IgE-binding epitopes on Candida albicans enolase. Clin Exp Allergy. 1995; 25: 529-535.<br>25. Platts-Mills TA, et al. The association of hypersensitivity diseases with dermatophyte infections. Clin Exp Allergy. 1992; 22: 427-428.<br>26. Yazdanbakhsh M, Sacks DL. Why does immunity to parasites take so long to develop? Nat Rev Immunol. 2010; 10: 80-81.<br>27. Friberg IM, Bradley JE, Jackson JA. Macroparasites, innate immunity and immunoregulation: developing natural models. Trends Parasitol. 2010; 26: 540-549.<br>28. Watanabe N, Bruschi F, Korenaga M. IgE: a question of protective immunity in Trichinella spiralis infection. Trends Parasitol. 2005; 21: 175-178.<br>29. Lynch NR, et al. Effect of anthelmintic treatment on the allergic reactivity of children in a tropical slum. J Allergy Clin Immunol. 1993; 92: 404-411.<br>30. Commins SP, Smith PH, Ownby DR. Clinical Significance of Immunoglobulin E. Middleton&#8217;s Allergy: Principles and Practice. Elsevier Inc. 2020, 1087-1096 p.<br>31. Josephs DH, Spicer JF, Corrigan CJ, Gould HJ, Karagiannis SN. Epidemiological associations of allergy, IgE and cancer. Clin Exp Allergy. 2013; 43: 1110-1123.<br>32. Jensen-Jarolim E, et al. AllergoOncology: the role of IgE-mediated allergy in cancer. Allergy. 2008; 63: 1255-1266.<br>33. Lindel\u00f6f B, Granath F, et al. Allergy and cancer. Allergy. 2005; 60: 1116-1120.<br>34. Van Hemelrijck M, et al. Immunoglobulin E and cancer: a meta-analysis and a large Swedish cohort study. Cancer Causes Control. 2010; 21: 1657-1667.<br>35. Atkins D, Malka-Rais J. Food allergy: transfused and transplanted. Curr Allergy Asthma Rep. 2010; 10: 250-257.<br>36. Gruber S, et al. Allergic sensitization in kidney-transplanted patients prevails under tacrolimus treatment. Clin Exp Allergy. 2011; 41: 1125-1132.<br>37. Wisniewski J, et al. De novo food sensitization and eosinophilic gastrointestinal disease in children post-liver transplantation. Clin Transplant. 2012; 26: 365-371.<br>38. Abdel-Hafez M, et al. Idiopathic nephrotic syndrome and atopy: is there a common link? Am J Kidney Dis. 2009; 54: 945-953.<br>39. Nielsen GD, et al. IgE-mediated sensitisation, rhinitis and asthma from occupational exposures. Smoking as a model for airborne adjuvants? Toxicology. 2005; 216: 87-105.<br>40. Lietuvos Respublikos Sveikatos apsaugos ministro 2000 m. sausio 28 d. \u012fsakymas Nr. 49 \u201eD\u0117l kompensuojam\u0173j\u0173 vaist\u0173 s\u0105ra\u0161\u0173 patvirtinimo\u201c (\u017din., 2000, Nr. 10-253).<br>41. Preparato charakteristik\u0173 santrauka. European Medicines Agency. Amsterdamas, 2020. [\u017ei\u016br\u0117ta 2020 m. balad\u017eio 4 d.] Prieiga per internet\u0105: <a href=\"https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/xolair\">https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/xolair<\/a>.<br>42. Zuberbier T, et al. The EAACI\/GA\u00b2LEN\/EDF\/WAO guideline for the definition, classification, diagnosis and management of urticaria. Allergy. 2018; 73: 1393-1414.<br>43. Ertas R, et al. The clinical response to omalizumab in chronic spontaneous urticaria patients is linked to and predicted by IgE levels and their change. Allergy. 2018; 7:705-712.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Imunoglobulinai&nbsp;E (IgE) sudaro tik 0,002&nbsp;proc. viso \u017emogaus Ig kiekio, ta\u010diau \u0161ie antik\u016bnai stipriausiai i\u0161 vis\u0173 jungiasi su antigenais ir savo receptoriais&nbsp;[1]. Nedidelis kiekis aktyvint\u0173 IgE molekuli\u0173 imunini\u0173 l\u0105steli\u0173 pavir\u0161iuje gali sukelti labai stiprias ir net gyvybei pavojingas reakcijas. IgE atradimas 1968 metais reik\u0161mingai pakeit\u0117 alergini\u0173 lig\u0173 patogenez\u0117s supratim\u0105 ir diagnostik\u0105&nbsp;[2], o gydymas biologine terapija monokloniniais&#8230;<\/p>\n","protected":false},"author":35,"featured_media":76096,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[27322],"tags":[],"site":[27238],"post_item_type":[27345],"class_list":["post-76095","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ligu-gydymas","site-sindromas-lt"],"acf":{"post_sites":[27238]},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/76095","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/users\/35"}],"replies":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/comments?post=76095"}],"version-history":[{"count":0,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/posts\/76095\/revisions"}],"acf:term":[{"embeddable":true,"taxonomy":"site","href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site\/27238"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media\/76096"}],"wp:attachment":[{"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/media?parent=76095"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/categories?post=76095"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/tags?post=76095"},{"taxonomy":"site","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/site?post=76095"},{"taxonomy":"post_item_type","embeddable":true,"href":"https:\/\/www.pasveik.lt\/lt\/wp-json\/wp\/v2\/post_item_type?post=76095"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}