人血免疫球蛋白在自身免疫性脑炎患者中的应用效果及对其免疫水平、死亡率的影响

Application effect of Human Blood Immunoglobulin on patients with autoimmune encephalitis and its influence on their immune level and mortality

目的探讨人血免疫球蛋白在自身免疫性脑炎患者中的应用及对患者免疫水平、死亡率的影响.方法选取2015年5月~2017年5月北京南苑医院、解放军总医院附属第一医院收治的42例自身免疫性脑炎患者作为研究对象,采用随机数字公式将其分为对照组(21例)和观察组(21例).对照组患者采用甲泼尼龙(甲强龙)治疗3周,观察组患者在对照组的基础上联合人血免疫球蛋白治疗3周.治疗完毕后,采用简易智能精神状态检查量表(MMSE)评估患者的认知水平;采用流式细胞仪测定两组患者治疗前、治疗后3周的CD3^+、CD4^+、CD8^+及CD4^+/CD8^+细胞水平;采用酶联免疫吸附试验测定两组患者治疗前、治疗后3周的降钙素原(PCT)、干扰素-γ(INF-γ)、白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平;随访12个月并统计两组患者治疗后的死亡率.结果两组患者治疗后1、2、3周的MMSE评分均显著高于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后1、2、3周的MMSE评分均显著高于对照组,差异有统计学意义(P<0.05).两组患者治疗后3周的CD3^+、CD4^+、CD4^+/CD8^+细胞水平均显著高于治疗前,CD8^+细胞水平显著低于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后3周的CD3^+、CD4^+、CD4^+/CD8^+细胞水平均显著高于对照组,CD8^+细胞水平显著低于对照组,差异有统计学意义(P<0.05).两组患者治疗后3周的PCT、INF-γ、IL-6及TNF-α水平均明显低于治疗前,差异有统计学意义(P<0.05);观察组患者治疗后3周的PCT、INF-γ、IL-6及TNF-α水平均明显低于对照组,差异有统计学意义(P<0.05).观察组患者治疗后4、8及12个月的死亡率均低于对照组,差异有统计学意义(P<0.05).结论人血免疫球蛋白治疗自身免疫性脑炎,有助于提高机体免疫功能,改善患者的认知功能,降低炎症因子水平及死亡率.

Objective To investigate the application effect of Human Blood Immunoglobulin on patients with autoimmune encephalitis and its influence on their immune level and mortality. Methods Forty-two patients with autoimmune encephalitis admitted to Beijing Nanyuan Hospital and the First Affiliated Hospital of PLA General Hospital from May2015 to May 2017 were enrolled in the study. They were divided into the control group(21 cases) and the observation group(21 cases) according to the random number formula. The patients in the control group were treated with Methylprednisolone(Sou-Medrol) for 3 weeks, and the patients in the observation group were treated with Human Blood Immunoglobulin for 3 weeks on the basis of the control group. After the treatment, the cognitive level of the patients was assessed by the mini-mental state examination(MMSE). The cell levels of CD3^+, CD4^+, CD8^+and CD4^+/CD8^+were measured by flow cytometry before and 3 weeks after treatment. The levels of procalcitonin(PCT), interferon-γ(INF-γ), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were measured by enzyme-linked immunosorbent assay before and 3 weeks after treatment in both groups. The patients were followed up for 12 months, and the mortality was counted between the two groups. Results The MMSE scores of the two groups at 1, 2, and 3 weeks after treatment were significantly higher than those before treatment, and the differences were statistically significant(P<0.05).The MMSE scores in the observation group at 1, 2, and 3 weeks after treatment were significantly higher than those in the control group, and the differences were statistically significant(P<0.05). The cell levels of CD3^+, CD4^+, CD4^+/CD8^+in the two groups at 3 weeks after treatment were significantly higher than those before treatment, and the cell level of CD8^+was significantly lower than that before treatment, with statistically significant differences(P<0.05). The cell levels of CD3^+, CD4^+, CD4^+/CD8^+in the observation group at 3 weeks after treatment were significantly higher than those in the control group, and the cell level of CD8^+was significantly lower than that in the control group, with statistically significant differences(P<0.05). The levels of PCT, INF-γ, IL-6 and TNF-α in the two groups at 3 weeks after treatment were significantly lower than those before treatment, and the differences were statistically significant(P<0.05). The levels of PCT, INF-γ, IL-6 and TNF-α in the observation group at 3 weeks after treatment were significantly lower than those in the control group, and the differences were statistically significant(P<0.05). The mortality of the observation group at 4, 8 and 12 months after treatment was lower than that of the control group, and the difference was statistically significant(P<0.05). Conclusion The usage of Human Blood Immunoglobulin in patients with autoimmune encephalitis contrubites to enhance the function of immunity, improve the cognition function of patients, and reduce the inflammatory factor levels and the mortality.