静脉用免疫球蛋白对脓毒症患儿免疫状态及转归的影响

Effect of intravenous immunoglobulin on immunity and outcome for sepsis in children

目的探讨静脉用免疫球蛋白（intravenous immunoglobulin，IVIG）对脓毒症患儿免疫状态以及转归的影响。方法2008年8月至2010年4月入住我院儿童重症医学科符合脓毒症诊断的患儿84例，分为对照组（48例）和治疗组（36例），治疗组一次性输注IVIG1g／kg，分别于用药前（0h）及用药后24h、72h和5d抽取两组患儿外周静脉血，在流式细胞仪上进行免疫细胞（CD3＋、CD4＋、CD56＋、CD29＋、CD8＋）计数，采用ELISA法检测细胞因子[肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-10、IL—17]水平并计算TNF-α／IL-10。比较两组患儿各时间点免疫细胞计数、细胞因子水平以及TNF-α／IL-10变化，并观察比较两组患儿28d病死率。结果治疗组患儿CD3＋、CD4＋、CD56＋、CD19＋细胞计数，TNF-α、IL—17以及TNF-a／lL—10在应用IVIG后24h、72h、5d均明显低于对照组（P〈0．05），并且呈进行性下降趋势；而IL-10则明显增高（P〈0．05），呈上升趋势；CD8＋细胞计数无明显变化。治疗组28d死亡10例（27．7％，10／36），对照组死亡8例（16．6％，8／48），两组比较差别无统计学意义（X2=1．50，P=0．169，OR=1．92，95％CI：0．671～5．510）。结论IVIG可使脓毒症患儿机体处于免疫麻痹状态，并不能提高存活率。

Objective To explore the effect of intravenous immunoglobulin （IVIG） on immunity and outcome for sepsis in children. Methods Eighty-four children who met the diagnosis of sepsis were included in study and divided into treatment group （36 cases ） and control group （48 cases）. The patients in teatment group were administered IVIG with the dose of 1 g/kg. Peripheral venous blood samples of patients in bαh groups were collected before （0 h） ,24 h,72 h and 5 d after administration to detect the numbers of immunocyte including CD3 ＋ ,CD4 ＋ ,CD56 ＋ ,CD19 ＋ ,CD8 ＋ cells by flow cytometry and the levels of cytokines including tumor necrosis factor （TNF）-ct, interleukin （IL）-10, IL-17 by enzyme linked immunosorbent assay. The numbers of immunocyte and levels of cytokines and TNF-α/IL-10 were compared and the mortality at 28 days was assessed between two groups. Results The numbers of CD3 ＋ , CD4 ＋ , CD56 ＋ , CD19 ＋ cells and the levels of TNF-α, IL-17 and TNF-oflL-10 of patients in teatment group were significantly decreased than those in control group at 24 h,72 h and 5 d afte administration （P 〈0. 05） and showed downtrend. However, the level of IL-10 increased significantly （ P 〈 0. 05 ） and showed uptrend in treatment group. The number of CD8 ＋ cells had no change. No difference of mortality was observed between two groups （27. 7%, 10/36 vs16.6% ,8/48,X2 = 1.50,P =0. 169,0R = 1.92,95% CI：0. 671 ＋5.510）.Conclusion IVIGcan suppress the immunity of children with sepsis and has no survival benefit.