静脉注射丙种球蛋白治疗早产儿感染的研究

Astudyonintravenousimmunoglobulinfortreatinginfectionsofprematureinfants

为了探讨静脉注射丙种球蛋白（ＩＶＩＧ）预防及治疗早产儿感染的价值，用单向免疫琼脂扩散法检测５１例出生１～３天（胎龄２８～３６周）的早产儿血清ＩｇＧ、ＩｇＡ、ＩｇＭ。结果显示ＩｇＧ均值随胎龄增加而升高（ｒ＝０．９９，Ｐ＜０．０１），２８～３６周者＜８．０ｇ／Ｌ（２８周仅４．５ｇ／Ｌ），＞３６周者＞８．０ｇ／Ｌ；而ＩｇＡ、ＩｇＭ差异无显著意义（２８～３６周者ＩｇＡ均值为６１５ｍｇ／Ｌ，＞３６周者为６２１ｍｇ／Ｌ；２８～３６周者ＩｇＭ均值为４２３ｍｇ／Ｌ，＞３６周者为４１８ｍｇ／Ｌ），，故胎龄越小越有应用静脉丙种球蛋白（ＩＶＩＧ）的指征。３０例重症感染的早产儿参考相似的孕周、体重及日龄，随机分为ＩＶＩＧ组及对照组各１５例，均选用同类抗生素，且不用其它免疫制剂及血浆治疗，ＩＶＩＧ组按每天０．５～１ｇ／ｋｇ稀释成５０ｍｌ在２～３小时内静脉滴注，连用２天，ＩＶＩＧ组治疗１周后均值从８．２ｇ／Ｌ升到１３．５ｇ／Ｌ（Ｐ＜０．０１）；而对照组治疗后ＩｇＧ均值仅６．７ｇ／Ｌ。提示早产儿感染用ＩＶＩＧ疗效十分满意。

Inordertostudythevalueofintravenousimmunogobulin(IVIG)intreatinginfec-tionsofprematureinfants,theserumlevelsofIgG,IgAandIgMweredeterminedin51prematureswithsingleimmuno-difusionthechnique.TheserumlevelofIgGincreasedwiththeincreaseofges-tationalage(GA)andthemeanofIgGwaspositivelycorelatedwithGA(r=0.99,P<0.01).ThemeanlevelofIgGwas<8.0g/Lin28～36weeksofGAand>8.0g/LinGAmorethan36weeks.ButIgAandIgMshowednosignificantdiferences.ThemeanlevelofIgAwas615mg/Lin28～36weeksofGAand621mg/LinGAmorethan36weeks.ThemeanlevelofIgMwas423mg/Lin28～36weeksofGAand418mg/LinGAmorethan36weeks.Therefore,thesmalertheGA,themoreIVIGwasindicated.ThirtyprematureneonateswithseriousinfectionsweredividedintoIVIGgroupandcontrolgroup.Alcasesweretreatedwithsimilarantibioticswithoutotherimmunepreparataions.Immunoglobulin0.5～1g·kg-1·d-1wasgivenbyintravenousinfusionwithin2～3hoursfortwodays.Afteroneweekoftreatment,themeanlevelofIgGincreasedto13.5g/LinIVIGgroup,muchhigherthan6.7g/Lofthecontrolgroup(P<0.01).ItissuggestedthatIVIGhassatisfactorytherapeuticefectivenessfortreatinginfectionsofprematureinfants.