丙种球蛋白联合干扰素治疗重症手足口病并病毒性脑炎患儿的疗效

Efficacy of Gamma Globulin Combined with Interferon in the Treatment of Severe Hand,Foot and Mouth Diseases Complicated with Viral Encephalitis

目的:探讨丙种球蛋白与干扰素联用治疗重症手足口病合并病毒性脑炎患儿的疗效及对患儿免疫系统及S100B、神经元特异性烯醇化酶(NSE)水平的影响。方法:收集2012年3月—2017年1月我院住院部纳入的68例重症手足口病合并病毒性脑炎患儿为研究对象,依据随机数字表法将患儿分为观察组和对照组,各34例。两组均给予常规治疗,对照组在此基础上加用注射用重组人干扰素α-1b(20μg与0.9%氯化钠注射液混合,ivgtt,bid)治疗,观察组在对照组基础上采用大剂量丙种球蛋白[1 g/(kg·d)]治疗。比较两组临床症状缓解时间、T淋巴细胞亚群水平及血清和脑脊液S100B、NSE水平变化。结果:观察组体温恢复正常时间、皮疹消退时间、精神状态好转时间及恶心呕吐缓解时间均短于对照组,差异有统计学意义(P<0.01);治疗后,观察组CD3+、CD4+水平高于对照组,CD8+水平低于对照组,差异有统计学意义(P<0.05或P<0.01);治疗后,观察组血清和脑脊液中S100B和NSE水平低于对照组,差异有统计学意义(P<0.05或P<0.01)。结论:大剂量丙种球蛋白联合干扰素治疗重症手足口病合并病毒性脑炎患儿的效果确切,可促进免疫系统恢复,降低患儿脑脊液和血清中S100B、NSE水平,值得临床推广应用。

Objective:To investigate the efficacy of gamma globulin combined with interferon in the treatment of severe hand,foot and mouth diseases complicated with viral encephalitis,and its effect on immune system and S100 B and neuron specific enolase(NSE)levels in the children.Methods:68 children with severe hand,foot and mouth diseases complicated with viral encephalitis in the Inpatient Department of our hospital from March 2012 to January 2017 were enrolled,and the children were randomly divided into an observation groups and a control group,34 cases each.The patients in the two groups were given conventional treatment.The patients in the control group were treated with recombinant human interferonα-1 b(20μg recombinant human interferonα-1 b was mixed with 0.9%sodium chloride injection,ivgtt,bid),and the patients in the observation group were treated with highdose gamma globulin[1 g/(kg·d)].The remission time of clinical symptoms,the level of T lymphocyte subsets and the levels of S100 B and NSE in serum and cerebrospinal fluid were compared between the two groups.Results:The time of body temperature returning to the normal level,the regression time of rash,the improving time of mental state and the remission time of nausea and vomiting in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.01).After treatment,the levels of CD3+and CD4+in the observation group were higher than those in the control group,while the level of CD8+was lower than that in the control group,with statistically significant differences(P<0.05 or P<0.01).After treatment,the levels of S100 B and NSE in serum and cerebrospinal fluid in the observation group were lower than those in the control group,with statistically significant differences(P<0.05 or P<0.01).Conclusion:High-dose gamma globulin combined with interferon is effective in the treatment of severe hand,foot and mouth diseases complicated with viral encephalitis,which can promote the recovery of immune system and reduce the levels of S100 B and NSE in cerebrospinal fluid and serum of the children,and is worthy of clinical application.