Globulin abnormalities

Introduction Most of the immunoglobulins in human plasma are present in gamma globulin (gamma-globulin). There are five categories, namely immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), immunoglobulin D (IgD), and immunoglobulin E (IgE). Among them, IgG is the most important immunoglobulin, accounting for about 70% of human plasma gamma globulin, with a molecular weight of about 150,000 and a sugar content of 2-3. The IgG molecule consists of 4 peptide chains. A peptide chain having a molecular weight of 25,000, which is called a light chain, has a molecular weight of 50,000, and is a heavy chain. The light chain and the heavy chain are connected by a disulfide bond (SS). Immunoglobulin is produced by the body after being stimulated by an antigen (such as a pathogen). Its main function is to react with the antigen to form an antigen-antibody complex, thereby blocking the damage of the pathogen to the body and causing the pathogen to lose its pathogenic effect. On the other hand, immunoglobulins sometimes have pathogenic effects. In patients with chronic hepatitis B, the long-term white and ball ratios are reversed, and there are signs of cirrhosis.

Cause

Globulin can be divided into four types: a1, a2, and r.

1 In the case of hepatic inflammatory lesions, a1 globulin increases, while a1 increase suggests that the condition is mild, and if the reduction is often marked, the condition is biased. Therefore, the determination of a1 globulin is useful for judging the severity and prognosis of patients with hepatitis.

2a2 globulin can also reflect the severity of hepatitis lesions. In the early stages of viral hepatitis, most of them maintain normal values and gradually increase thereafter. In severe hepatitis, such as a2 globulin reduced to less than 0.4 gram%, suggesting that the patient will have or has developed hepatic coma. In liver cancer, a2 globulin tends to increase. A2 contains lipoproteins, when cholestasis, especially in chronic cases, a2 globulin increases as blood lipids increase. In decompensated cirrhosis, a2 globulin is mostly reduced.

3 globulin is mostly increased in cholestasis of liver disease. In the case of severe damage to liver cells, beta globulin is reduced due to reduced liver synthesis, and may be reduced to less than 6%.

4r globulin is increased in almost all cases of hepatobiliary disease. In viral hepatitis, r globulin is moderately elevated and is generally expected to recover within 2-3 months. If r globulin continues to increase without explanation for other reasons, it often means that the disease has a poor outcome and has been converted to chronic hepatitis or cirrhosis. In severe hepatitis, r globulin can be significantly increased, even reaching 2.5 g% -3 g%. If r globulin increases to more than 2 times normal, the transaminase is more than 5 times normal. And if there is no improvement for 10 weeks, it can be confirmed as subacute severe hepatitis. If it is not treated, the prognosis is dangerous. In chronic hepatitis, the mean value of r globulin varies with the disease type. The cirrhosis of r-globulin is generally increased, especially in advanced or progressive decompensated cirrhosis, and r globulin can be extremely increased.

an examination

Related inspection

Serum globulin (G, GL0) blood routine

There are many methods for detecting immunoglobulin abnormal proliferative diseases, and generally two or more detection methods should be used to confirm each other. When clinically suspected MM, macroglobulinemia, heavy chain, light chain disease or other plasma C malignant lesions, the following procedures are used:

1 serum zone electrophoresis analysis, found abnormal globulin zone;

2Ig quantitative test or qualitative detection of urine protein, which is a preliminary screening test;

3 pairs of positive patients should be used for immunoelectrophoresis or immunofixation electrophoresis for classification and identification.

4 further as a subtype quantitative determination of Ig and serum and urine light chain quantification and ratio calculations as a confirmatory test;

5 benign and malignant difference: benign immunoglobulin hyperplasia, its light chain content increased with the heavy chain, 1:1, the ratio has no obvious abnormalities; malignant hyperplasia light chain and heavy chain ratio is inconsistent, not 1:1, light The chain ratio can also change abnormally;

6 also need to combine the bone marrow and imaging, pathology test to make a correct diagnosis.

Differential diagnosis

Differential diagnosis of globulin abnormalities:

Dysgammaglobulinemia: selective or part immunoglobulin deficiencies: refers to the deficiency of one or more immunoglobulins; and the remaining immunoglobulins The protein is normal or elevated. It belongs to primary humoral immunodeficiency disease.

Chronic hepatitis B: Symptoms are generally characterized by loss of appetite, general malaise, greasy food, nausea, pain in the liver area, jaundice (sclera on the sclera, skin), swelling of the liver (feeling), tenderness, snoring, Liver palm, spider mites, telangiectasia or liver disease, and some cases are accompanied by splenomegaly. If you have these symptoms, you should go to the hospital as soon as possible to check the diagnosis. For example, hepatitis B can be diagnosed by liver function and hepatitis B (two pairs of hepatitis B) or hepatitis B virus DNA.

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