静注丙种球蛋白联合糖皮质激素治疗急性重症病毒性心肌炎的临床研究

The study of the effects of intravenous human immunoglobulin with Glucocorticoid in acute severe viral myocarditis

目的研究应用静注丙种球蛋白联合糖皮质激素治疗急性重症病毒性心肌炎的效果。方法回顾研究自2005年1月至2016年5月治疗的急性重症病毒性心肌炎患者共69例,按照治疗方法分为两组。研究组为常规治疗基础上,应用了静注丙种球蛋白联合糖皮质激素治疗;对照组为常规治疗基础上,应用了静注糖皮质激素治疗,未应用静注丙种球蛋白治疗。比较两种方法对该病死亡率、治愈率的影响。结果研究组病死率为18.75%,治愈率为81.25%;应用超声心动图检查观察心功能变化,多数在2至5天基本恢复正常。对照组病死率为75.68%,治愈率为24.32%。对两组存活的11例患者进行随访1年至10年,超声心动图检查均正常。研究组与对照组不同治疗方法的效果比较有显著性差异（χ~2=22.25,P〈0.01）。结论在急性重症病毒性心肌炎的治疗中,在常规治疗的基础上,结合对症处理,应用糖皮质激素联合经静脉注射丙种球蛋白可明显地提高对该病的治愈率。

Objective： To study the effects of intravenous human immunoglobulin with glucocorticoid in treatment of a cute severe viral myocarditis. Methods： Retrospective analysis was made in 69 cases with a cute severe viral myocarditis in my hospital during 10 years from 2005 to 2016. They were divided into two groups,the study group with intravenous human immunoglobulin and glucocorticoid in therapy,and the contrast group without intravenous human immunoglobulin in therapy. The effects of two methods in fatality rate and cure rate for this disease were compared. Results： thirty- two cases of the study group were treated immediately with intravenous human immunoglobulin 20 g. qd and glucocorticoid dexamethasone10 mg qd for 7 days after diagnosis. The fatality rate was 18. 75%,and cure rate was 81. 25%. The cardiac function was recovered within 2 to 5 days after treatment in echocardiogram. Thirtyseven cases of the contrast group without intravenous human immunoglobulin in the therapy,which were treated only with dexamethasone 10 mg qd. The fatality rate was75. 68%,and the cure rate was 24. 32%. All the cases were treated with routine methods. Eleven viable cases were followed up for 1 to 10 years,their cardiogram were normal. There was significant difference between the two groups（ χ^2= 22. 25,P〈0. 01）. Conclusion： On the basis of the routine methods,the use of intravenous human immunoglobulin and glucocorticoid in therapy of a cute severe viral myocarditis can raise the cure rate,.