免疫球蛋白治疗免疫损害宿主合并重症肺炎的疗效

Clinical Effects of Immunoglobulin on Severe Pneumonia in Immunocompromised Host

目的:探讨免疫球蛋白(immunoglobulin,Ig)治疗免疫损害宿主(immunocompromised host,ICH)合并重症肺炎的临床疗效。方法:将非人类免疫缺陷病毒(non-human immunodeficiency virus,non-HIV)感染的ICH合并重症肺炎的86例患者随机分为2组:静脉注射IgG治疗组(Ig治疗组,n=46)和常规治疗组(对照组,n=40)。对照组给予常规治疗;Ig治疗组除给予常规治疗外,同时给予IgG 0.4g/(kg.d)静脉注射,疗程为5d。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)方法测定患者治疗前及治疗第6天血液中的IgG、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和人白介素-6(interleukin 6,IL-6)的浓度。结果:Ig治疗组患者入组第6天急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation scoring system,APACHE)II评分显著低于对照组,其血清中IgG的浓度显著高于对照组,且TNF-α和IL-6的浓度显著低于对照组,差异有统计学意义(P<0.05)。Ig治疗组病死率39.1%,对照组病死率为62.5%,2组比较P<0.05。结论:静脉注射IgG治疗可以提高ICH患者体内IgG浓度,减轻炎性反应,改善患者的病情和预后。

Objective： To explore the effects of immunoglobulin on severe pneumonia in immunocompromised host （ICH）. Methods..A total of 86 ICH caused by non-human immunodeficiency virus （non-HIV） with severe community acquired pneumo- nia （SCAP） were divided into two groups,the Ig therapy group and the control group. Patients in the Ig therapy group received 0.4g/（kg · d） immunoglobulin besides normal therapy, while patients in the control group were treated with routine therapy. The concentrations of IgG, tumor necrosis factor-α （TNF-α） and interleukin 6 （IL-6） in serum were measured by enzyme linked immunosorbent assay （ELISA）. Results： After treatment for 5 days, the acute physiology and chronic health evaluation scoring system （APACHE II） scores in the therapy group were significantly lower than those in the control group. The concentration of IgG in the therapy group was significantly higher than that in the control group. Moreover, the serum levels of TNF- and IL-6 were significantly lower in the therapy group compared with the control group. The mortality rate in the therapy group （39.1 % ） was significantly lower than that in the control group（62.5 % ）. Conclusions： Ig is effective in the treatment of severe pneumonia in ICH. IgG can significantly decrease the concentrations of TNF-αand IL-6, and it can also improve the prognosis of SCAP in ICH.