靜脈注射人類免疫球蛋白 (IVIG)
Immune Globulin (Human), Intravenous (IVIG)
Fractionated human immunoglobulins (primarily intact IgG)
別名: hIVIG · IGIV · Felbogamma · Octagam · Gammaplex · Gamunex · Gammagard · Privigen · Carimune NF · immunglobuline · immunoglobulinas · Immune Serum
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Immune-mediated diseases (IMHA, ITP) - General | 0.3-1.5 grams/kg | IV | varies | varies | 🌎 NA |
| IMHA (refractory to conventional treatment) | 0.5-1.5 grams/kg | IV | once | over 12 hours | 🌎 NA |
| Primary immune-mediated thrombocytopenia (pIMT) | 0.5 grams/kg | IV | single infusion | — | 🌎 NA |
| Refractory erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, and other cutaneous adverse drug reactions | 0.5-1 gram/kg | IV | 1-2 times, 24 hours apart | over a 4-6 hour period; may need to be repeated for 3-4 days in a row | 🌎 NA |
- Immune-mediated diseases (IMHA, ITP) - General: Cost-benefit must be weighed carefully due to extreme expense.
- Refractory erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, and other cutaneous adverse drug reactions: Uses a 5-6% solution.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
靜脈注射人類免疫球蛋白 (IVIG) 是一種高濃度的生物製劑，由數千名人類血漿捐贈者中提取的免疫球蛋白（主要為 IgG）組成。
在獸醫學中，它主要作為一種昂貴的標示外急救療法，用於當傳統免疫抑制療法（如糖皮質激素或環孢素）失效時的嚴重、難治性免疫介導疾病。
主要臨床應用：
- 原發性免疫介導性血小板減少症 (pIMT)： 在獸醫研究中顯示出促進血小板快速恢復的最大潛力。
- 免疫介導性溶血性貧血 (IMHA)： 用於難治性病例，儘管前瞻性研究顯示其在提高存活率方面的結果好壞參半。
- 免疫介導性皮膚病： 例如多形性紅斑、史蒂芬斯-強森症候群 (SJS) 和中毒性表皮壞死鬆解症。
臨床要點： 由於 IVIG 是人類血液製品，考慮到人類供應短缺的倫理問題、極高的藥物成本以及對外來蛋白質產生過敏反應的風險，其在獸醫學中的應用存在爭議。
作用機轉
IVIG exerts complex immunomodulatory effects through multiple concurrent pathways rather than a single mechanism:
- Fc Receptor Blockade: The massive influx of human IgG binds to and saturates Fc receptors on the patient's mononuclear phagocyte system (macrophages) → prevents the phagocytosis and destruction of the patient's own autoantibody-coated red blood cells or platelets.
- Anti-idiotypic Antibodies: Contains antibodies that directly bind to and neutralize pathogenic autoantibodies.
- Cytokine Modulation: Binds to and downregulates pathogenic cytokines including Interleukin (IL)-1a, IL-6, and Tumor Necrosis Factor-alpha (TNF-α).
- Receptor Interference: Binds to CD5 receptors and T-cell receptors, suppressing pathogenic T-cell and B-cell activation.
- Negative Feedback: High circulating IgG levels provide negative feedback → downregulation of endogenous antibody production by B lymphocytes.
安全性與警告
禁忌症
- Prior hypersensitivity reactions to human albumin or human blood products
不良反應
- Increased blood pressure
- Local injection site reactions (pain, tenderness)
- Anaphylaxis / Hypersensitivity reactions
- Volume overload (due to colloid-like properties)
- Thrombotic events
- Fever, chills, facial flushing, nausea (human data)
- Renal dysfunction / Acute renal failure (human data)
注意事項
BLACK BOX WARNING (Human Label): IVIG has been associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death in humans.
- Hypersensitivity: IVIG contains trace amounts of human albumin, which can trigger severe hypersensitivity or anaphylaxis in dogs, especially upon repeated exposure.
- Infusion Rates: Adverse reactions are strongly associated with rapid infusion. Must be infused slowly (typically over a 6-12 hour period in dogs).
- Volume Overload: IVIG has colloid-like properties; use with caution in patients with compromised cardiac or renal function.
- Laboratory Interference:
- Blood Glucose: Can cause falsely elevated readings on glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ) based monitors. Use glucose oxidase or other unaffected methods.
- Coombs Test: Passively transferred antibodies may cause false-positive serological test results.
藥物交互作用
IVIG may interfere with the immune response and efficacy of the vaccine due to passively transferred antibodies.
監測
- Vital signs (blood pressure, temperature, heart rate)
- Lung auscultation (to assess for pulmonary edema/volume overload)
- Renal function tests (BUN, Creatinine) and urine output
- Clinical efficacy (e.g., serial platelet counts, hematocrit, dermatological lesion resolution)
藥物動力學
半衰期
吸收
Rapid onset of action following intravenous administration.
分佈
Widely distributed in plasma.
代謝
Eliminated primarily by catabolism. Fever or active infection may increase catabolism and consumption, thereby decreasing the half-life.
排除
Catabolism
過量
Overdosage primarily increases the risk of fluid volume overload due to the colloid-like osmotic pull of the concentrated proteins. Other reactions could include severe pain and tenderness at the injection site, and potentially an increased risk of thrombotic events or renal impairment.
可用產品
劑型
- Injection solution (5%, 10%)
- Lyophilized powder for solution
人用標示
- Immune Globulin (Human) Injection 5% (50 mg/mL) preservative-free (Felbogamma, Octagam, Gammaplex)
- Immune Globulin (Human) Injection 10% (100 mg/mL) preservative-free (Gamunex, Gammagard, Privigen)
- Immune Globulin (Human) Lyophilized Powder for Solution (Carimune NF, Gammagard S/D)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Usually stored at room temperature, but specific storage requirements vary by manufacturer and product formulation (refer to the specific package insert). Do not freeze. Do not mix with other medications (though some products like Privigen may be diluted with D5W if necessary).
飼主須知
寵物主人重要須知：
- 藥物簡介： IVIG 是一種由濃縮抗體組成的高度專業化人類血液製品。當寵物的免疫系統攻擊自身且所有標準療法均無效時，它被用作嚴重自身免疫性疾病的「最後手段」。
- 費用： 這種藥物非常昂貴（單次治療通常需要花費數千美元），因為它是從人類血漿捐贈者中提取的。
- 風險： 由於它是人類蛋白質，狗有發生過敏反應（包括嚴重的過敏性休克）的風險。它還可能導致體液超載，或者在極少數情況下引起腎臟問題或血栓。
- 預期情況： 藥物會在醫院內以非常緩慢的靜脈 (IV) 點滴方式給予，通常需要 6 到 12 小時。雖然它可以挽救生命，但無法保證一定有效，通常只保留給對所有其他標準療法均無反應的寵物使用。
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