新生兒臍帶血中之特異性IgG與IgE抗體與母體的相關性

Abstract

過敏是全球常見的文明病，盛行率逐年上升，據世界衛生組織(WHO)及相關權威機構調查，全世界約有22% 的人口患有過敏方面的疾病。在台灣，因地屬海島型氣候，濕熱、季節溫差大，且空氣污染嚴重，近年來，台灣過敏疾病的盛行率也同樣快速攀升，與世界趨勢相同。 由於過敏疾病的高盛行率、多樣性與難以治癒的特性，造成醫療及社會成本的沉重負擔。過敏患者或其家屬，無論在生活品質或心理方面都同樣深受衝擊。 過敏的病理機轉，除了與免疫系統密切相關外，也常受到環境中過敏原或非過敏刺激因素的影響，如塵蟎、花粉，食物，黴菌，以及溫度等因素，使得免疫系統產生大量特異性抗體IgE、IgG，引發過敏反應，造成氣喘、過敏性鼻炎、異位性皮膚炎、蕁麻疹及其他過敏疾病。目前研究發現，過敏體質也具有遺傳傾向之特性(氣喘、異位性皮膚炎、牛皮癬…)。 近幾年的流行病學調查裡，顯示現在台灣嬰幼兒的過敏比例越來越高，許多嬰幼兒一直被氣喘、過敏性鼻炎、或者異位性皮膚炎所折磨。其實，這些孩子的過敏體質，很可能是媽媽在懷孕期間，食物的選擇不當所造成。文獻指出，具過敏體質的母親，其血清中特異性IgE、IgG多偏高，且胎兒臍帶血中的特異性IgE、IgG也同樣偏高，這顯示母親在懷孕的過程中，如果有過敏的問題，可能會讓胎兒也產生過敏體質，而且多數的過敏可能是食物所造成的。 為建構一個合理的過敏預防計畫，必須進一步了解母體對胎兒的影響，並確認胎兒的致敏是否源自孕、產婦的免疫系統影響。 本研究係將台安醫院婦產科門診所轉介之20對產婦、新生兒，藉由過敏原微陣列晶片檢測系統，偵測產婦、新生兒血清中的 123種過敏原特異性 IgE與 IgG抗體。檢測分析後發現，母血與臍帶血的過敏原特異性 IgE、IgG抗體的濃度、分佈相當一致，IgE抗體在母體與新生兒間的平均相關係數為0.75，IgG抗體的平均相關係數更高達0.87。尤在患有過敏病症的母親，其趨勢更為明顯，這顯示過敏原特異性IgE、IgG 抗體很可能為母源性的轉移，且母親的過敏體質在懷孕時即可能對胎兒具有持續性的影響。 藉由使用新型過敏原晶片檢測，兼具高通量、準確特性的檢驗工具，期能正確完整的檢測出孕婦過敏原種類，使有效避開過敏原，減少胎兒早期致敏，並達預防勝於治療之效，這應是未來值得期待的醫療檢驗及產前評估過敏兒風險的方法。

Allergy is commonly encountered disorder throughout civilization, and rapidly increases prevalence in recent years. According to the World Health Organization (WHO) surveillance data, about 22% of the world’s population suffer from allergic diseases. Owing to hot and humid climate, and air pollution in Taiwan, the prevalence of allergic disease become a big problem in clinical setting and public health. Allergic patients and their families experience a significant impact on their quality of life. The pathology of allergic diseases is affected by dysregulation in immune system , and the environmental stimulants such as dust mites, pollen, food, mold, temperature and other factors. All of these factors stimulate immune system to produce a large amount of specific antibodies: “IgE” and “IgG”, to induce a broad spectrum of allergic diseases, such as asthma, allergic rhinitis, atopic dermatitis, urticaria and other allergic diseases. Many studies have revealed that allergy may originate from a genetic predisposition and can be passed from generation to generation. Recent investigation suggest that allergy may originate from mothers’ choice of food during the pregnancy period. It is conceivable that mothers with allergy often have high titer of serum specific IgE and IgG as well as those of fetal umbilical cord blood. These may indicate that allergies experienced during pregnancy may influence the occurrence of allergy in infant in the later life especially by food allergen. The aim of this present study aims to construct a reasonable allergy prevention plan which focuses on understanding the inter-relationship between mother and fetal allergy. This clinical research was conducted in Department of obstetrics and gynecology Tai-An Hospital(outpatient referrals) recruiting involving 20 pairs of mothers and their newborns. Utilizing an innovative protein micro-array technology, the participants were detected for 123 allergens of the levels of allergen specific IgE and IgG antibodies in their serum. The results showed that the allergen specific IgE and IgG levels in the maternal blood were highly correlated to the levels found in the umbilical cord blood. The average ratio of IgE was 0.75 , while the average ratio of IgG was higher at 0.87. Mothers who suffer from allergic diseases, the tendency was even more prominent. This study further indicates that the allergen-specific IgE, and IgG antibodies is transferred from maternal circulation to the fetal blood, and allergic status of the mother during pregnancy may impact on the fetus. In conclusion, by using the new technology of high throughput allergen chip to detect the maternal blood. It is possible to predict the allergic status and the context of the allergens. This strategy may probably be used in the prevention of allergen stimulation in newborn.