what does it mean to have a high iga level?
Clin Exp Immunol. 2008 Jan; 151(ane): 42–50.
Serum levels of immunoglobulins (IgG, IgA, IgM) in a general adult population and their relationship with booze consumption, smoking and common metabolic abnormalities
A Gonzalez-Quintela
*Departments of Internal Medicine, Pontevedra, Spain
R Alende
*Departments of Internal Medicine, Pontevedra, Espana
F Gude
†Departments of Clinical Epidemiology, Pontevedra, Espana
J Campos
*Departments of Internal Medicine, Pontevedra, Spain
J Rey
‡Departments of Principal Intendance Unit, A-Estrada, Pontevedra, Kingdom of spain
Find articles by J Rey
L M Meijide
‡Departments of Chief Care Unit, A-Estrada, Pontevedra, Spain
C Fernandez-Merino
‡Departments of Primary Care Unit, A-Estrada, Pontevedra, Spain
C Vidal
§Departments of Allergy, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Pontevedra, Spain
Abstract
The present study investigated serum immunoglobulin (Ig) concentrations in relation to demographic factors, common habits (booze consumption and smoking) and metabolic abnormalities in an adult population-based survey including 460 individuals. Serum levels of interleukin (IL)-6, a mark of inflammation, were besides adamant. After adjusting for confounders, male person sex was associated positively with IgA levels and negatively with IgM levels. Age was associated positively with IgA and IgG levels. Smoking was associated negatively with IgG levels. Heavy drinking was associated positively with IgA levels. Metabolic abnormalities (obesity and metabolic syndrome) were associated positively with IgA levels. Abdominal obesity and hypertriglyceridaemia were the components of metabolic syndrome associated almost strongly with serum IgA. Heavy drinkers with metabolic syndrome showed particularly high serum IgA levels. Serum IL-six levels were correlated positively with IgA and IgG concentrations. It is concluded that sex, age, booze consumption, smoking and common metabolic abnormalities should be taken into account when interpreting serum levels of IgA, IgG and IgM.
Keywords: alcohol, immunoglobulins, metabolic syndrome, obesity, smoking
Introduction
Serum immunoglobulin levels are adamant routinely in clinical exercise considering they provide key information on the humoral immune status. Low immunoglobulin (Ig) levels define some humoral immunodeficiencies [1]. In contrast, loftier immunoglobulin levels (polyclonal gammopathy) are observed in liver diseases, chronic inflammatory diseases, haematological disorders, infections and malignancies [2]. Moreover, immunoglobulin levels assist in the diagnosis of some disorders, particularly liver diseases [3–7].
Determining the distribution of immunoglobulin levels in general populations is important for interpreting reference values. The common guidelines for definition and determination of reference intervals in the clinical laboratory note that division should be considered when at that place are significant differences among subgroups defined by age, sex and common exposures such as smoking or booze consumption [viii–x]. Even so, studies focusing upon the possible influences of these factors on serum immunoglobulin levels are scarce. Information technology has been reported that IgM levels are higher in females than in males [11–13]. Besides, serum immunoglobulin concentrations tend to increase with age [11,xiv]. Information technology is well known that heavy drinkers with advanced liver disease oft present with high IgA values [v,15–17], but fewer studies have addressed the furnishings of smoking and alcohol intake (from light to heavy) per se on serum IgA, IgG or IgM [18].
An increase in serum IgA levels is a generalized phenomenon in diabetic patients [nineteen,20]. Chronic inflammation is a fundamental characteristic of type two diabetes, obesity and metabolic syndrome [21,22], a cluster of abnormalities characterized by insulin resistance forth with specific adventure factors including hyperglycaemia, visceral adiposity, dyslipidaemia and high blood force per unit area [23,24]. Production of proinflammatory cytokines is increased in patients with metabolic syndrome [25,26]. These include adipocytokines such as interleukin (IL)-vi [25,27], which is a co-factor for immunoglobulin synthesis [28–thirty] and a mutual mark of inflammation [31]. Obesity and metabolic syndrome, the paradigms of metabolic abnormalities, are mutual in many populations, and their worldwide prevalences have increased dramatically during recent decades. To the best of our knowledge, no previous study has been focused upon a possible association of these common metabolic abnormalities with serum immunoglobulin levels.
Taken together, these information emphasize the need for multivariate analyses in gild to detect confounding or interactions amidst all these factors that are associated with each other as well as with immunoglobulin levels. In this adult population-based study, nosotros investigated serum immunoglobulin (IgA, IgG and IgM) levels in relation to (i) demographic factors (historic period and sex); (ii) common environmental exposures (alcohol consumption and smoking); and (three) mutual metabolic abnormalities, including the components of metabolic syndrome. In improver, we investigated the possible human relationship between immunoglobulin concentrations and serum levels of IL-6.
Methods
Study population
The present study took advantage of a survey of the full general developed population from the municipality of A-Estrada, in north-western Spain. The study was intended primarily to investigate immunological alterations associated with alcohol consumption. Detailed descriptions of study methodology and population sample characteristics accept been reported elsewhere [32]. Briefly, an historic period-stratified random sample (n = 720) of the adult population (> xviii years of age) of the municipality was drawn from the Wellness Intendance Registry, which covers > 95% of the population. A full of 469 individuals consented to participate. Of these, a serum sample for immunoglobulin determination (see below) was available for 460 individuals. The median age of these individuals was 54 years (range 18–92 years). All participants were Caucasians. A total of 203 (44·1%) were males.
Nomenclature of alcohol consumption and smoking
Booze consumption was evaluated by the organisation of standard drinking units [33], which sums the number of spectacles of vino (∼ 10 g), bottles of beer (∼ 10 1000) and units of spirits (∼ 10 g) consumed regularly per week. Individuals with habitual alcohol consumption of 1–140 grand/calendar week (n = 140, 30·4%) were considered light drinkers, those with alcohol consumption of 141–280 g/week (n = 53, 11·5%) were considered moderate drinkers and those with alcohol consumption of > 280 1000/week (n = 46, ten·0%) were considered heavy drinkers. The balance (northward = 221, 48·0%), alcohol abstainers or very occasional booze drinkers, were included in the same group. Consumers of at least one cigarette per day were considered smokers. Individuals who had quit smoking during the preceding year were still considered smokers.
Definition of metabolic abnormalities
The trunk mass index (BMI) was calculated every bit the weight (in kg) divided by the square of the tiptop (in metres). Following standard criteria, individuals were classified as normal weight (< 25 kg/thou2), overweight (25–30 kg/m2) or obese (> 30 kg/m2).
Metabolic syndrome was defined past the Developed Treatment Panel Three criteria [23] that include: (i) abdominal obesity (waist circumference > 102 cm in males or > 88 cm in females); (ii) hypertriglyceridaemia (fasting serum triglycerides ≥ 150 mg/dl); (iii) low loftier-density lipoprotein (HDL)-cholesterol levels (fasting HDL-cholesterol < 40 mg/dl in males or < fifty mg/dl in females); (iv) increased blood pressure (arterial claret pressure ≥ 130/≥ 85 mmHg or current anti-hypertensive medication apply); and (v) hyperglycaemia (fasting serum glucose ≥ 110 mg/dl or current anti-diabetic therapy). Individuals who met at least three of these criteria (n = 114, 24·viii%) were classified every bit having metabolic syndrome, as reported previously [34]. Missing data included BMI in one case, waist circumference in two cases, serum triglycerides in one case and HDL-cholesterol in one example. The remaining criteria were enough to classify these cases equally having or defective metabolic syndrome. Routine laboratory determinations were performed with an Olympus AU-400 analyser (Olympus, Tokyo, Japan).
Specific laboratory determinations
Serum immunoglobulins (IgG, IgA and IgM) levels were determined by a commercial nephelometry assay using a BN-2 device (Dade Behring, Marburg, Germany). The manufacturer indicates the following reference intervals for healthy adults: IgA 70–400 mg/dl, IgG 700–1600 mg/dl and IgM 40–230 mg/dl [35].
Serum IL-six was determined by a commercial chemiluminescent enzyme immunoassay (Immulite™; DPC, LA, CA, United states). The lower threshold for detection of IL-half-dozen with this method is two pg/ml. For the present study, serum levels > 10 pg/ml (corresponding to the ∼95th percentile in the studied population) were considered abnormally loftier.
Statistical analyses
Cross-tabulation significance levels were based on second-club corrected Pearson'southward χ2 for chiselled variables. The Mann–Whitney U-test, the Kruskal–Wallis test and the Jonckheere–Terpstra test (for trend analysis) were employed for comparison of quantitative variables. In some descriptions, the two·5th and the 97·5th percentiles were given as measures of dispersion as an arroyo to reference values [nine]. Serum IL-half dozen concentrations were considered in categories considering the bulk of individuals presented with undetectable IL-half dozen levels and the distribution of values was highly skewed to the correct. Linear regression was employed for multivariate analyses with serum immunoglobulin levels as dependent variables. For covariates, age (in years) entered the equation as a quantitative variable, and binary variables entered the equation as '1' ('present' or 'yes') or '0' ('absent' or 'no'). Dummy variables were created for not-binary categorical variables, using the lowest category as the reference. Variables were forced to enter the equation in all models. To account for the stratified sampling, a design-based analysis including compensatory weights was performed for the estimation of immunoglobulin levels in the overall population. The Stata 7·0 package (Stata Corp., College Station, TX, United states) and the SPSS packet (SPSS Inc., Chicago, IL, USA) were employed. Two-tailed P-values < 0·05 were considered statistically pregnant.
Ethical considerations
All subjects consented to participate in the study. The study conformed to the Helsinki Declaration and was reviewed and approved by the local Enquiry Commission.
Results
Overall distribution of serum immunoglobulin levels in the population
The levels of all 3 immunoglobulins (IgA, IgG, IgM) approached a normal distribution, although slightly skewed to the right (Fig. i). The only case of frank immunoglobulin deficiency was a female with nearly undetectable IgA levels (weighted prevalence, 0·2%, 95% CI 0–0·six%).
Histograms of serum immunoglobulin levels in the population studied. The calculation of means, medians, standard deviations (s.d.), 2·5th and 97·fifth percentiles (P = 2·5 and P = 97·5, respectively) were weighted co-ordinate to the report design.
Relation of serum immunoglobulin levels with age and sex
Serum IgA levels were college in males than in females (Tabular array 1). Conversely, serum IgG and serum IgM levels were higher in females than in males (Table 1). These differences between sexes were observed throughout all age ranges (Fig. 2). Serum IgA and serum IgG levels tended to increase with age (P for tendency < 0·001 in both cases). This trend was observed in both sexes (Fig. two). Serum IgM showed no significant variation with historic period (P for trend = 0·54) (Fig. two).
Table i
Serum immunoglobulin (Ig) levels in relation to sex, alcohol consumption, and smoking.
| No. | IgA (mg/dl) | IgG (mg/dl) | IgM (mg/dl) | |
|---|---|---|---|---|
| Sex | ||||
| Female person (reference) | 257 | 228 (82–470) | 1120 (694–1760) | 147 (50–398) |
| Male | 203 | 274 (89–624)*** | 1060 (701–1803)* | 112 (40–305)*** |
| Alcohol consumption† | ||||
| Abstainers (reference) | 221 | 231 (92–503) | 1120 (680–1818) | 137 (44–375) |
| Light drinkers | 140 | 239 (78–579) | 1095 (742–1784) | 131 (48–386) |
| Moderate drinkers | 53 | 263 (54–733) | 1050 (599–1625)* | 130 (36–416) |
| Heavy drinkers | 46 | 318 (63–569)*** | 1075 (466–1922) | 124 (xl–509) |
| Smoking | ||||
| Not-smokers (reference) | 361 | 250 (89–564) | 1110 (741–1760) | 132 (46–367) |
| Smokers | 99 | 224 (74–730) | 995 (628–1775)*** | 137 (43–428) |
Serum immunoglobulin levels in relation to sexual activity and historic period strata. Serum immunoglobulin A (IgA) levels were higher in males than in females in all age strata (P < 0·001), and also tended to increment with age (P for tendency < 0·001). Serum IgG levels were higher in females than in males in all age strata (P < 0·05), and tended to increase with age (P for trend < 0·001). Serum IgM were higher in females than in males in all age strata (P < 0·001), only showed no significant variation with historic period.
Relation of serum immunoglobulin levels with booze consumption and smoking
Serum IgA levels tended to increase in parallel with booze consumption (P for trend < 0·001) (Table 1). Accordingly, the highest IgA levels were observed in heavy drinkers, who exhibited significantly higher IgA levels than those of abstainers (P < 0·001), low-cal drinkers (P = 0·001) and moderate drinkers (P = 0·04). In contrast, IgG and IgM levels did not increase with alcohol consumption. Indeed, IgG levels tended to be lower in moderate consumers than in abstainers (Tabular array 1).
Serum IgG levels were lower in smokers than in not-smokers (P < 0·001) (Table 1). Serum levels of IgA and IgM in smokers were not significantly different from those of non-smokers (Table 1).
Relation of serum immunoglobulin levels with mutual metabolic abnormalities
Obese individuals showed higher serum IgA levels than individuals with normal weight (P = 0·006) or overweight (P = 0·005) (Table 2). In univariate analyses, increased serum IgA levels were establish in individuals with most whatever component of metabolic syndrome, i.e. abdominal obesity, hypertriglyceridaemia, hyperglycaemia or high claret pressure (Table ii). Therefore, serum IgA levels were significantly higher in individuals with metabolic syndrome than amid patients without it (Table 2). IgG and IgM levels showed no consequent relationship with metabolic abnormalities, although individuals with dyslipidaemia (either hypertriglyceridaemia or depression HDL-cholesterol levels) exhibited higher IgM levels than individuals without it. Individuals with high claret pressure besides showed higher IgG, just this association became less strong after adjusting for age and sexual activity (see below).
Tabular array ii
Serum immunoglobulin levels in relation to common metabolic abnormalities.
| No. | IgA (mg/dl) | IgG (mg/dl) | IgM (mg/dl) | |
|---|---|---|---|---|
| Body mass index† | ||||
| Normal weight (reference) | 125 | 233 (fourscore–531) | 1050 (713–1852) | 141 (42–412) |
| Overweight | 194 | 238 (90–588) | 1095 (734–1760) | 126 (46–370) |
| Obese | 140 | 270 (87–583)** | 1130 (676–1777)* | 129 (40–394) |
| Abdominal obesity‡ | ||||
| No (reference) | 328 | 232 (88–519) | 1085 (726–1755) | 136 (46–389) |
| Yep | 130 | 270 (98–585)*** | 1130 (674–1789) | 127 (39–397) |
| Hyperglycaemia‡ | ||||
| No (reference) | 349 | 233 (87–523) | 1090 (718–1760) | 136 (46–395) |
| Yeah | 111 | 278 (84–696)*** | 1080 (677–1928) | 123 (33–370) |
| Hypertriglyceridaemia‡ | ||||
| No (reference) | 375 | 233 (88–527) | 1090 (702–1760) | 128 (42–375) |
| Yes | 84 | 293 (76–668)*** | 1065 (686–1880) | 148 (65–435)** |
| Low HDL-cholesterol levels‡ | ||||
| No (reference) | 330 | 238 (81–573) | 1090 (689–1782) | 122 (41–377) |
| Yes | 129 | 254 (106–583) | 1130 (704–1760) | 149 (62–430)*** |
| High claret pressure‡ | ||||
| No (reference) | 144 | 214 (84–427) | 1040 (698–1502) | 141 (43–396) |
| Yes | 316 | 264 (89–583)*** | 1110 (697–1841)** | 129 (45–385) |
| Metabolic syndrome‡ | ||||
| No (reference) | 346 | 228 (84–522) | 1090 (735–1773) | 133 (42–384) |
| Yes | 114 | 298 (139–635)*** | 1120 (667–1778) | 137 (lx–408) |
Multivariate analyses of factors associated with serum immunoglobulin levels
A multiple linear regression model that adjusted for age, sexual activity, booze intake, smoking condition and metabolic syndrome confirmed that serum IgA levels were associated positively and independently with male sex (P < 0·001), ageing (P = 0·001), heavy drinking (P = 0·02) and metabolic syndrome (P < 0·001). Furthermore, the presence of metabolic syndrome tended to modify the issue of heavy drinking on serum IgA levels and vice versa, with IgA levels beingness particularly high among individuals with both atmospheric condition (Fig. three). When the v components of metabolic syndrome were introduced to the model, hypertriglyceridaemia and intestinal obesity were the only components of the syndrome that maintained significant associations with IgA levels (P = 0·001 and P = 0·02, respectively). In the same model, hyperglycaemia showed borderline significance (P = 0·ten). These 3 metabolic factors (abdominal obesity, hypertriglyceridaemia and hyperglycaemia) had an condiment effect on serum IgA levels (Fig. 4).
Serum immunoglobulin A (IgA) levels in relation to the number of metabolic syndrome criteria [23]. Serum IgA levels tended to increase equally the number of criteria increased (P for trend < 0·001). *Criteria considered here included only abdominal obesity, hypertriglyceridaemia and hyperglycaemia, three of the five criteria of metabolic syndrome [23] that showed an independent association with serum IgA levels or a trend toward and association.
Serum immunoglobulin A (IgA) levels in relation to the presence of metabolic syndrome and heavy drinking. Serum IgA levels were increased in heavy drinkers and in patients with metabolic syndrome, simply were particularly high in heavy drinkers with metabolic syndrome (P < 0·001 with respect to every other category).
In a like linear regression model, serum IgG levels were associated positively and independently with ageing (P = 0·001). In addition, IgG levels were associated negatively and independently with moderate drinking (P = 0·01) and with smoking (P = 0·02). Serum IgM levels were associated positively and independently with female sex (P < 0·001).
Relation of serum IL-half-dozen levels with serum immunoglobulin concentrations
A total of 355 individuals (77·2%) had undetectable (< 2 pg/ml) serum IL-half-dozen levels, 77 (16·7%) had IL-6 levels of 2–10 pg/ml and the remaining 28 (six·1%) had high (> 10 pg/ml) IL-6 levels. Serum IgA and IgG (but not IgM) tended to increase in parallel with these categories of serum IL-6 levels (P for trend = 0·01, 0·03 and 0·59, respectively) (Fig. 5). No lucent associations were observed between IL-vi levels and sexual activity, alcohol consumption, smoking or any of the common metabolic abnormalities studied (data not shown). The proportion of individuals with detectable (≥ two pg/ml) IL-6 levels tended to increase with age, from 11·1% in individuals anile eighteen–30 years to 31·9% in those older than fourscore years (P for trend = 0·03). The association betwixt age (in years) and detectable IL-6 levels was nevertheless nowadays later adjusting for sex, alcohol intake, smoking and metabolic syndrome in a logistic regression model [odds ratio (OR) ane·014, 95% confidence interval (CI) ane·001–1·028, P = 0·03].
Serum immunoglobulin (Ig) levels in relation to serum levels of interleukin (IL)-half-dozen. Serum IgA and serum IgG tended to increase as the level of IL-half dozen increased (P for tendency = 0·01 and 0·03, respectively).
Discussion
This comprehensive study in a general developed population shows that serum concentrations of serum immunoglobulins vary widely with age, sexual practice, common habits and metabolic abnormalities. According to our results, median IgA values may be 20% higher in males, whereas median IgM values may exist thirty% higher in females. Sex differences in immunoglobulin concentrations, specifically loftier IgM levels in females, accept been attributed to hormonal furnishings on B lymphocytes [36,37]. Such sex differences may exist particularly important when interpreting immunoglobulin levels in diseases with diff sexual activity distribution. For instance, increased serum IgM levels are a characteristic diagnostic characteristic of primary biliary cirrhosis, which has a strong female predominance [iv,6,vii]. Besides, significant increases in serum IgA and IgG were observed with age. Such increases may reverberate the accumulation of chronic inflammatory weather condition with ageing. In fact, there was some parallelism betwixt IgA and IgG concentrations and serum concentrations of IL-six, a marker of inflammation and a co-factor for immunoglobulin synthesis [28–xxx]. In addition, the nowadays results show that sexual activity- and age-related changes in immunoglobulin concentrations are independent of potential confounders such as smoking, alcohol consumption and mutual metabolic abnormalities.
The observed variations in serum immunoglobulins with booze consumption and smoking confirm those reported by McMillan et al. in the Irish population [18]. In addition, the present study shows that these findings are independent of potential confounders. Serum IgA levels tended to increase with booze consumption, existence higher in heavy drinkers than in light-to-moderate drinkers and abstainers. It is known that serum IgA levels are higher in alcoholic cirrhosis than in non-cirrhotic alcoholic liver affliction [five,15–17], suggesting that alcoholic liver disease per se plays a office in IgA elevation. In fact, alcoholic liver illness has been defined as an IgA-associated disorder [38]. Withal, as shown in the present and previous studies [eighteen,39], a milder IgA increment is found in heavy drinking individuals with minimal or no liver disease, suggesting that chronic booze intake per se besides contributes to increased serum IgA values. Of note, IgA increase in heavy drinkers is selective, non affecting IgM or IgG. Moreover, serum IgG concentrations tend to exist lower in moderate booze consumers than in abstainers. This finding is consistent with previous reports [18] and is independent from smoking, which is also associated with depression IgG levels, every bit shown hither and in previous studies [xviii]. Taken together, these findings ostend that both smoking [40] and alcohol consumption [41] have meaning immunomodulatory effects.
At that place take been previous reports of increased serum IgA concentrations in diabetic patients [19,20], just to our noesis there were no previous studies examining IgA concentrations in patients with metabolic syndrome, an insulin-resistant state characterized by a constellation of metabolic abnormalities [23,24]. The nominal definition of metabolic syndrome is constantly changing [42], and for this reason the components of the metabolic syndrome were considered separately. Increased IgA concentrations tended to be associated with hyperglycaemia, simply associations with boosted components of metabolic syndrome such every bit hypertriglyceridemia and intestinal obesity were even stronger. These iii factors had an additive issue on serum IgA levels. Immunoglobulin meridian was selective, affecting only the IgA form, with the exception of an IgM increase in individuals with dyslipidaemia. The mechanisms of IgA top in individuals with obesity and metabolic syndrome are unknown, but IgA peak is non surprising because both weather condition are chronic inflammatory disorders [21,22]. Serum levels of IL-6, an inflammatory marker, were associated with those of serum IgA. Even so, serum IL-half dozen levels were not establish to be associated with metabolic abnormalities in the nowadays series. Elevated IgA levels in patients with obesity and metabolic syndrome could be of clinical importance in relation to IgA-related disorders. Information technology is well known that obesity and metabolic syndrome may accompany and worsen IgA nephropathy [43–45]. The possible role of increased IgA concentrations in the development or progression of IgA nephropathy in patients with these metabolic disorders should exist investigated further. Interestingly, nosotros observed an epidemiological interaction between heavy drinking and metabolic syndrome in relation to IgA levels, the latter being especially high in individuals with both weather. Of notation, some parallels exist between obesity/metabolic syndrome and the consequences of heavy drinking in that both are chronic inflammatory disorders, share about identical histological liver findings (steatohepatitis) [46], are associated with IgA nephopathy [43–45,47] and are associated with increased serum IgA levels, as reported here. Furthermore, metabolic abnormalities change the upshot of heavy drinking in the development of alcoholic liver disease, the latter beingness more frequent and astringent amid patients with obesity/metabolic syndrome [48]. Further studies are also needed in social club to ascertain the mechanisms of biological interactions between alcohol consumption and obesity/metabolic syndrome as IgA-related conditions.
In summary, the nowadays study shows that serum concentrations of the master immunoglobulin isotypes may be affected by common factors. Serum IgA is associated positively with age, male sex, heavy drinking, obesity and metabolic syndrome. Serum IgG is associated positively with historic period and negatively with smoking and moderate drinking. Finally, serum IgM is associated positively with female sex. These features may be important considering serum immunoglobulin levels are used ordinarily in routine clinical exercise. The results of the present study cannot be taken as reference values, because the sample represents the general adult population and non 'healthy' individuals [ix]. Future studies aimed at defining reference immunoglobulin values should consider sectionalisation past these factors. Besides, these factors should be taken into account when interpreting serum levels of IgG, IgA and IgM.
Acknowledgments
This study was supported by the Fondo de Investigaciones Sanitarias (1306/99) and the Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP, RD06/0018/0006), Instituto de Salud Carlos Iii, Castilian Ministry of Health.
References
one. Buckley RH. Humoral immunodeficiency. Clin Immunol Immunopathol. 1986;xl:13–24. [PubMed] [Google Scholar]
ii. Dispenzieri A, Gertz MA, Therneau TM, Kyle RA. Retrospective accomplice written report of 148 patients with polyclonal gammopathy. Mayo Clin Proc. 2001;76:476–87. [PubMed] [Google Scholar]
iii. Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–38. [PubMed] [Google Scholar]
four. Yamamoto Grand, Terada R, Okamoto R, et al. A scoring organization for primary biliary cirrhosis and its application for variant forms of autoimmune liver affliction. J Gastroenterol. 2003;38:52–nine. [PubMed] [Google Scholar]
5. Van de Wiel A, van Hattum J, Schuurman HJ, Kater L. Immunoglobulin A in the diagnosis of alcoholic liver illness. Gastroenterology. 1988;94:457–62. [PubMed] [Google Scholar]
6. Martin DM, Vroon DH, Nasrallah SM. Value of serum immunoglobulins in the diagnosis of liver disease. Liver. 1984;4:214–18. [PubMed] [Google Scholar]
7. Taal BG, Schalm SW, de Bruyn AM, de Rooy FW, Klein F. Serum IgM in primary biliary cirrhosis. Clin Chim Acta. 1980;108:457–63. [PubMed] [Google Scholar]
viii. National Committee for Clinical Laboratory Standards (NCCLS) How to define and make up one's mind reference intervals in the clinical laboratory; approved guideline. 2. Wayne, PA: NCCLS; 2000. NCCLS document C-28-A2. [Google Scholar]
ix. Horn PS, Pesce AJ. Reference intervals: an update. Clin Chim Acta. 2003;334:5–23. [PubMed] [Google Scholar]
ten. Sasse EA. Determination of reference intervals in the clinical laboratory using the proposed guideline National Committee for Clinical Laboratory Standards C28-P. Arch Pathol Lab Med. 1992;116:710–13. [PubMed] [Google Scholar]
11. Maddison SE, Relmen CB. Normative values of serum immunoglobulins by single radial immunodiffusion: a review. Clin Chem. 1976;22:594–601. [PubMed] [Google Scholar]
12. Stoica G, Macarie East, Michiu V, Stoica RC. Biologic variation of human immunoglobulin concentration. I. Sex–age specific effects on serum levels of IgG, IgA, IgM and IgD. Med Interne. 1980;xviii:323–32. [PubMed] [Google Scholar]
13. Giltay EJ, Fonk JC, von Blomberg BM, Drexhage HA, Schalkwijk C, Gooren LJ. In vivo effects of sexual activity steroids on lymphocyte responsiveness and immunoglobulin levels in humans. J Clin Endocrinol Metab. 2000;85:1648–57. [PubMed] [Google Scholar]
fourteen. Ichihara One thousand, Itoh Y, Min WK, et al. Diagnostic and epidemiological implications of regional differences in serum concentrations of proteins observed in vi Asian cities. Clin Chem Lab Med. 2004;42:800–9. [PubMed] [Google Scholar]
fifteen. Latvala J, Hietala J, Koivisto H, Jarvi K, Anttila P, Niemela O. Allowed responses to ethanol metabolites and cytokine profiles differentiate alcoholics with or without liver disease. Am J Gastroenterol. 2005;100:1303–ten. [PubMed] [Google Scholar]
16. Gluud C, Tage-Jensen U. Autoantibodies and immunoglobulins in alcoholic steatosis and cirrhosis. Acta Med Scand. 1983;214:61–6. [PubMed] [Google Scholar]
17. Gonzalez-Quintela A, Vidal C, Gude F, et al. Increased serum IgE in alcohol abusers. Clin Exp Allergy. 1995;25:756–64. [PubMed] [Google Scholar]
18. McMillan SA, Douglas JP, Archbold GPR, McCrum EE, Evans AE. Event of depression to moderate levels of smoking and alcohol consumption on serum immunoglobulin concentrations. J Clin Pathol. 1997;l:819–22. [PMC free commodity] [PubMed] [Google Scholar]
19. Rodriguez-Segade South, Camiña MF, Paz JM, Del Rio R. Aberrant serum immunoglobulin concentrations in patients with diabetes mellitus. Clin Chim Acta. 1991;203:135–42. [PubMed] [Google Scholar]
20. Rodriguez-Segade Southward, Camiña MF, Carnero A, et al. High serum IgA concentrations in patients with diabetes mellitus: agewise distribution and relation to chronic complications. Clin Chem. 1996;42:1064–7. [PubMed] [Google Scholar]
21. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444:860–7. [PubMed] [Google Scholar]
22. Singh B, Mallika V, Goswami B. Metabolic syndrome: diagnosis, potential markers and direction − an update. Clin Chim Acta. 2007;380:4–12. [Google Scholar]
23. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the 3rd report of the National Cholesterol Education Program (NCEP) skillful console on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) JAMA. 2001;285:2486–97. [PubMed] [Google Scholar]
24. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881–7. [PubMed] [Google Scholar]
25. Ronti T, Lupattelli G, Mannarino Due east. The endocrine office of adipose tissue: an update. Clin Endocrinol. 2006;64:355–65. [PubMed] [Google Scholar]
26. Pradhan Advertizement, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive poly peptide, interleukin-6, and risk of developing blazon 2 diabetes mellitus. JAMA. 2001;286:327–34. [PubMed] [Google Scholar]
27. Fried SK, Bunkin DA, Greenberg AS. Omental and subcutaneous adipose tissues of obese subjects release interleukin-6: depot difference and regulation by glucocorticoid. J Clin Endocrinol Metab. 1998;83:847–50. [PubMed] [Google Scholar]
28. Kunimoto DY, Nordan RP, Strober Westward. IL-6 is a potent cofactor of IL-i in IgM synthesis and of IL-5 in IgA synthesis. J Immunol. 1989;143:2230–v. [PubMed] [Google Scholar]
29. Deviere J, Content J, Denys C, et al. Immunoglobulin A and interleukin 6 form a positive secretory feedback loop: a study of normal subjects and alcoholic cirrhotics. Gastroenterology. 1992;103:1296–301. [PubMed] [Google Scholar]
30. Beagley KW, Eldridge JH, Lee F, et al. Interleukins and IgA synthesis. Human and murine interleukin 6 induce loftier rate secretion in IgA-committed B cells. J Exp Med. 1989;169:2133–48. [PMC free commodity] [PubMed] [Google Scholar]
31. Browning LM, Krebs JD, Jebb SA. Discrimination ratio analysis of inflammatory markers: implications for the written report of inflammation in chronic disease. Metabolism. 2004;53:899–903. [PubMed] [Google Scholar]
32. Gonzalez-Quintela A, Gude F, Boquete O, et al. Association of alcohol consumption with total serum immunoglobulin E levels and allergic sensitization in an developed population-based survey. Clin Exp Allergy. 2003;33:199–205. [PubMed] [Google Scholar]
33. Gual A, Martos AR, Lligona A, Llopis JJ. Does the concept of a standard potable utilize to viticultural societies? Alcohol Alcohol. 1999;34:153–60. [PubMed] [Google Scholar]
34. Meijide LM, Rey J, Fernandez-Merino MC, et al. Prevalencia del síndrome metabólico y de la enfermedad cardiovascular. Estudio en una población rural [Prevalence of metabolic syndrome and cardiovascular disease. A study in a rural population] Cad Aten Primaria. 2006;13:75–80. [Google Scholar]
35. Dati F, Schumann G, Thomas L, et al. Consensus of a grouping of professional societies and diagnostic companies on guidelines for acting reference ranges for 14 proteins in serum based on the standardization against the IFCC/BCR/CAP Reference Cloth (CRM 470) Eur J Clin Chem Clin Biochem. 1996;34:517–twenty. International Federation of Clinical Chemistry, Customs Bureau of Reference of the Commission of the European Communities, College of American Pathologists. [PubMed] [Google Scholar]
36. Kanda Northward, Tamaki K. Estrogen enhances immunoglobulin production past human PBMCs. J Allergy Clin Immunol. 1999;103:282–8. [PubMed] [Google Scholar]
37. Bouman A, Heineman MJ, Faas MM. Sexual practice hormones and the immune response. Hum Reprod Update. 2005;11:411–23. [PubMed] [Google Scholar]
38. Van de Wiel A, Schuurman HJ, Kater L. Alcoholic liver illness: an IgA associated disorder. Scand J Gastroenterol. 1987;22:1025–30. [PubMed] [Google Scholar]
39. Gonzalez-Quintela A, Alende MR, Gamallo R, et al. Serum immunoglobulins (IgG, IgA, IgM) in chronic hepatitis C. A comparison with non-cirrhotic alcoholic liver affliction. Hepatogastroenterology. 2003;50:2121–6. [PubMed] [Google Scholar]
41. Szabo G. Consequences of alcohol consumption on host defence. Alcohol Alcohol. 1999;34:830–41. [PubMed] [Google Scholar]
42. Federspil One thousand, Nisoli Eastward, Vettor R. A disquisitional reflection on the definition of metabolic syndrome. Pharmacol Res. 2006;53:449–56. [PubMed] [Google Scholar]
43. Kaartinen K, Syrjanen J, Porsti I, et al. Insulin resistance and the progression of IgA glomerulonephritis. Nephrol Dial Transplant. 2007;22:778–83. [PubMed] [Google Scholar]
44. Mustonen J, Syrjanen J, Rantala I, Pasternack A. Clinical course and treatment of IgA nephropathy. J Nephrol. 2001;xiv:440–6. [PubMed] [Google Scholar]
45. Ross WR, McGill JB. Epidemiology of obesity and chronic kidney disease. Adv Chronic Kidney Dis. 2006;13:325–35. [PubMed] [Google Scholar]
46. Reid AE. Non-alcoholic steatohepatitis. Gastroenterology. 2001;121:710–23. [PubMed] [Google Scholar]
47. Cecchin Due east, De Marchi S. Alcohol misuse and renal harm. Aficionado Biol. 1996;1:7–17. [PubMed] [Google Scholar]
48. Diehl AM. Obesity and alcoholic liver disease. Alcohol. 2004;34:81–7. [PubMed] [Google Scholar]
Articles from Clinical and Experimental Immunology are provided here courtesy of British Order for Immunology
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276914/
Post a Comment for "what does it mean to have a high iga level?"