丙种球蛋白治疗新生儿缺氧缺血性脑病的临床观察

Effects and immune function of IVIG on neonates with hypoxic - ischemic encephalopathy

目的探讨静脉丙种球蛋白（IVIG）治疗新生儿缺血缺氧性脑病（HIE）的临床疗效及免疫功能。方法将48例HIE患儿随机分为常规组和IVIG组各24例。IVIG组在常规治疗组方案基础上加用IVIG,400 mg/（kg·d）,静脉滴注,每日1次,连用3 d。并设30例健康新生儿作对照组。检测血清IgA、IgG、IgM和外周血T淋巴细胞亚群。比较治疗前后的临床疗效和免疫功能变化。结果①HIE患儿血清IgA、IgG、IgM、CD3、CD4、CD8水平均明显低于健康对照组;②静脉滴注IVIG后,可迅速提高HIE患儿血清IgG水平,同时可提高CD3、CD4和CD8水平,P均〈0.01;③IVIG组治愈率为87.5%,明显高于常规组66.7%（P〈0.05）。而平均治愈天数较常规组明显缩短（P〈0.01）。病死率由16.7%降至8.3%。结论免疫功能紊乱可能与HIE有关。IVIG治疗HIE疗效肯定,不良反应少。

Objective To investigate the clinical and immune efficiency of intravenous immunoglobulin （IVIG） manufacture do mestically as a complementary way in treating neonates with hypoxic - ischemic encephalopathy（ HIE ）. Methods Forty -eight patients with HIE were randomly divided into two groups： twenty -four patients were treated with routine treatment,while the other group（ IVIG group） was treated with routine treatment and infusion of IVIG[400 mg/（kg · d） ,iv,qd] for three days. The level of IgA,IgG,IgM in serum and the peripheral T lymphocyte subsets were measured. Results （1）The level of IgA, IgG, IgM, CD3, CD4 , CDs in HIE significantly depressed, compared with the control group. （2）Following the IVIG therapy, the level of IgG,CD3 ,CD4 ,CDs increased quickly, P all 〈0. 01. （3）The cure rate was 87. 5% in IVIG group,which was significantly higher than that in routine group （66. 7%, P 〈0. 05）. The course of treatment was shorter than that in routine group（ P 〈0. 01 ）. The fatality was reduced from 16. 7% to 8. 3%. Conclusion Our study indicated that HIE may be related to disorder in immune function. IVIG was safe and effective in treating HIE.