甲泼尼龙联合丙种球蛋白治疗单纯疱疹病毒性脑炎的临床观察

Clinical observation of effects of combined methylprednisolone and gamma globulin on treatment of herpes simplex viral encephalitis

目的探讨甲泼尼龙联合丙种球蛋白(IVIG)治疗单纯疱疹病毒性脑炎(HSE)的疗效。方法将71例HSE患者随机分为治疗组35例和对照组36例,对照组使用阿昔洛韦及地塞米松常规等治疗,治疗组在常规治疗的基础上激素换用甲泼尼龙冲击治疗(500mg/d),并加用丙种球蛋白400mg.kg-1.d-1,连用3～5d。比较2组治疗前后神经功能缺损评分、总有效率、脑脊液检查、脑电图及血清神经元特异性烯醇化酶(NSE)含量的变化。结果治疗组神经功能的恢复、总有效率、脑脊液检查、脑电图及血清NSE的恢复情况均明显优于对照组,差异有统计学意义(P<0.05)。结论甲泼尼龙联合IVIG治疗HSE疗效显著,明显提高了抢救成功率及治愈率,降低合并症及后遗症的发生,值得临床进一步推广。

Objective To observe effects of combined methylprednisolone and gamma globulin in treatment of herpes simplex virus encephalitis（HSE）. Methods 71 patients with HSE were randomly divided into the treat- ment group and the control group. The treatment group has 35 patients and the control group has 36 patients. The control group received acyclovir combined dexamethasone of conventional dose. The treatment group received acy- clovir combined methylprednisolone （500 mg/d） and gamma globulin（ 400 mg · kg-1 . d-1）for 3- 5 days. The changes of neurological deficit score, the total efficiency, cerebrospinal fluid examination, EEG and serum NSE levels in different groups were analyzed. Results The changes of neurological function recovery, the total efficien- cy, cerebrospinal fluid examination, EEG, and serum NSE levels in treatment group were significantly better than those in the control group （P〈0.05）. Conclusion The treatment of acyclovir combined methylprednisolone and gamma globulin in patients with HSE had a significant effect, significantly increased the survival rate and cure rate and reduced the incidence of complications and sequelae. It is worthy of further promotion.