免疫球蛋白静脉滴注对重症手足口病患儿血清炎性因子水平的影响

Changes of serum inflammatory factors level with intravenous immunoglobulin in children with severe handfoot-mouth disease

目的研究静脉滴注免疫球蛋白对重症手足口病患儿血清炎性因子水平的影响。方法将2009年4至6月收治的手足口病患儿40例，根据病情分为普通病例组（20例）和重症病例组（20例），单纯隐睾或斜疝儿童20例为对照组。20例手足口病重症病例组出现神经系统受累，但无心肺功能损害。重症病例组入院第1天及第2天分别予静脉滴注免疫球蛋白1g/（kg·d），用酶联免疫吸附试验分别检测血清肿瘤坏死因子（TNF）-d、白细胞介素（IL）-6和IL-10含量。结果普通病例组、重症病例组治疗前，重症病例组治疗后及对照组TNF-a含量分别为（71．70±12．35）、（152．20±59．99）、（150．95±61．77）、（36．65±10．46）ng／L，IL-6含量分别为（14．50±3．83）、（59．35±13．27）、（25．30±7．58）、（16．40±6．63）ng／L，IL-10含量分别为（9．82±2．20）、（38．19±8．54）、（23．30±5．21）、（9．32±2．08）ng／L。重症病例组血清TNF-d、IL-6和IL-10含量均高于普通病例组和对照组（P〈0．01），静脉滴注免疫球蛋白治疗后重症病例组血清IL-6和IL-10明显降低（君〈0．01），但血清TNF．d水平治疗前后差异无统计学意义（P〉0．05）。普通病例组血清TNF-a含量高于对照组（P〈0．01），普通病例组血清IL-6和IL-a含量与对照组比较，差异无统计学意义（P〉0．05）。结论静脉滴注免疫球蛋白可明显降低重症手足口病患儿血清IL-6和IL-10水平。

Objective To study changes of TNF-a, IL-6 and IL-10 level with intravenous immunoglobulin in children with severe hand-foot-mouth disease. Methods Fourty children with hand-foot-mouth disease（HFMD） and 20 children with simply cryptorchidism or hernia were investigated from April to June in 2009. They were divided into three groups ： common HFMD group （ n = 20）, severe HFMD group （ n = 20） and control group （ n = 20 ）. Children with severe HFMD had nervous system involvement without cardiopulmonary function damage and they received intravenous immunoglobulin （IVIG） at a dosage of 1 g/（ kg. d） respectively on the first and next day after admission. The levels of TNF-a, IL-6 and IL-10 were detected by enzyme-linked immunosorbent assay. Results The levels of TNF-a in common HFMD group, severe HFMD group before IVIG, severe HFMD group after IVIG and control group were （ 71.70 ± 12. 35 ） ng/L, （ 152. 20± 59. 99 ） ng/L, （ 150. 95± 61.77 ） rig/L, （ 36. 65± 10.46）ng/L respectively. The levels of IL-6 in common HFMD group, severe HFMD group before IVIG, severe HFMD group after IVIG and control group were （ 14. 50 ± 3. 83 ） rig/L, （59. 35± 13. 27 ） ng/L, （25. 30±7. 58 ） ng/L, （ 16.40 ±6. 63 ） ng/L respectively. The levels of IL-10 in common HFMD group, severe HFMD group before IVIG, severe HFMD group after IVIG and control group were （9.82 ± 2. 20） ng/L, （38.19 ± 8. 54） rig/L, （23.30 ± 5.21 ）ng/L, （9.32± 2. 08 ）ng/L respectively. The levels of TNF-a, IL-6 and IL-10 in severe HFMD group were higher than those in control group and common HFMD group （P 〈 0. 01 ）. Plasma levels of IL-6 and IL-10 significantly decreased in severe HFMD group after administration of IVIG（ P 〈 0.01 ）. There were no significant differences in the level of TNF-a before and after IVIG （ P 〉 0. 05 ）. Conclusion Plasma levels of IL-6 and IL-10 levels significantly decrease in children with severe HFMD after administration of IVIG.