Investigation Of Primary Humoral Immunodeifciency Disease In Yunnan And Correlation Analysis On CVID Lymphocyte Phenotype Characteristics With PLCγ2Gene

1ObjectivesPrimary humoral immunodeficiency is a disease harmful to human health, with the problem of delayed diagnoses all over the world. Its pathogenesis has not been clear yet, its role in the development of B cells and in the primary humoral immunodeficiency disease was still uncertain, though correlated with the mutationof PLCγ2gene. To investigate the morbidity situation of primary humoral immunodeficiency disease and to establish of reference values of human serum immunoglobulin levels of all ages for the Yunnan regions, by the determination of immunoglobulin level from serum blood samples in each age group. To further discuss the polymorphism of PLCγ2and the abnormal of CVID lymphocyte in Primary humoral immunodeficiency disease.2MethodsFrom2,2009to2,2012, total of1371human serum samples from newborn to adults were collected from affiliated Hospita of Dali University, DaliPeople’s Hospital, Dali Maternal and Child Care Service Centre and Dali CDC. One-way quantitative detection plate of unidirectional agar diffusion was selected for the determination of IgG, IgA, and IgM levels of the serum samples andits reference value was established. Meanwhile, the clinical characteristics of primary humoral immunodeficiency, the determination of immunoglobulin levels and flow cytometry (FCM) were used to explore lymphocyte phenotype characteristics in peripheral blood of suspected PID patients. DNA-PCR-SSCP was used to further analyze the correlation between the lymphocyte phenotype abnormalities of CVID patients.with the polymorphism of PLCy2gene.3Results1.1Human serum IgG and IgM contents inYunnan regions had differences between the sex (IgG:t=-2.138, P=0.033<0.05; IgM:t=-2.176, P=0.030<0.05) while IgA content had not (t=-0.141, P=0.888>0.05). The three human serum immunoglobulin contents were higher of women than men and they gradually increased with age. The human serum IgG, IgM and IgA content of all age groups also showed a significant difference (IgG:F=70.474, P=0.000<0.01; IgM: F=27.183, P=0.000<0.01; IgA:F=297.403, P=0.000<0.01). We got the normal value of the serum immunoglobulin contents and references value of different ages in Yunnan were abtained by the research. Its also had significant differences between the reference value and other report datas.1.2According to the warning symptoms of PID and the determination of immunoglobulin levels,21CVID patients (9males and12females) were diagnosed in Yunnan, aged betwwen2and79years and the average age is29.22. Its occurred to both male and females [median of sex differences:31, interquartile range (IQR):4.6-44]. Clinical manifestations were dominated for infection; also with blood cell reduction, autoimmune diseases, cancer, and so on. Three kinds of serum immunoglobulins of CVID patients were dominated by single individuals’ reduction, among them, IgM (100%) decreased most significantly.1.3B lymphocyte phenotype characteristics of CVID patients:Memory B cells (CD27+/CD19+) and non-isotype switched memory B cells (IgD+/CD27+/CD19+) of CVID patients both were lower than those of healthy individuals, and were statistically significant (the former:t=2.047, P=0.000<0.01; the latter:t=1.612, P=0.011<0.05); peripheral blood B cells (CD19+) were also lower compared with healthy people, but there was no significance (t=0.526, P=0.945>0.05), they all did not reach significant standard and only had the number reduction. Immature B cells (CD21+/CD19+), isotype switched memory B cells (IgD-/CD27+/CD19+) and the mature naive B cells (IgD+/CD27-/CD19+) all were higher than those of the healthy individuals, also without statistical significance and also only had the number increasment (T values were0.7300.768and0.744, P>0.05).1.4T lymphocyte phenotype characteristics of CVID patients:CD4+/CD8+ratio inverted, the number of CD45RA+T cells reduced, the number of CD45RO+T cells increased, but without statistical significance and only with the number changes.(T values were respectively1.184,0.921,0.500and0.667, P>0.05).1.5The PLCγ2gene variation by genomic DNA-PCR-SSCP analysis indicated that among the21cases with PLCγ2gene mutation, there were16cases with mutation in the32exon detection, PLCγ2gene mutation rate in the CVID patients was significantly higher than those in the suspected CVID patient group (76.19%vs0.22%, χ2=7.646, P=0.006, OR=11.20,95%CI=1.735-72.30). The difference was statistically significant (P<0.01).25variant in the32exon were found among the30patients, while the mutation position and the relation with the CVID disease yet has been uncertain. And needs to be further studied.2Conclusions2.1By the determination of immunoglobulin level of lots of serum samples revealed that there existed difference of the content of immunoglobulin on both age and gender in Yunnan Province. And the reference values and the content of immunoglobulin in each age group were obtained for the first time. The reference values of immunoglobulin were different to the other reported information. So, we need to take every factors into consideration when diagnosing the immunoglobulin level in clinic.2.2There are some PID patients be in Yunnan Province, because21cases of CVID patients were diagnosed in Yunnan Province for the first time in this study. So we must pay more attention to distinguish these rare diseases at the early stage during the medical service.2.3The research showed CVID patients with dysfunction of lymphocyte in development, mature and activation, main on the phenotypic changes of B lymphocytes and T lymphocytes. B lymphocytes phenotypic characteristics:the number of the memory B cells and non-isotype switched memory B cells in the CVID patients were lower than those in the healthy individuals and had significant differences. Peripheral blood B cells decreased while immature B cells, isotype-switched memory B cells and the mature naive B cells increased. T lymphocytes phenotypic characteristics of CVID patients:the number of peripheral blood T cells reduced; CD4+/CD8+ratio inverted, naiveT-cell reduced, memory T cells increased.2.4The PLCy2gene mutation was analyzed by the genomic DNA-PCR-SSCP. PLCy2gene detected in CVID patients presented the highly polymorphism, which related to CVID. Gene variations increased the susceptibility of CVID, which consistent with documents. PLCy2gene may be associated with the incidence of primary humoral immunodeficiency disease.