基因重组干扰素γ治疗呼吸道合胞病毒所致毛细支气管炎的临床疗效分析

Recombinant interferon gamma(rIFNγ)therapy in infants with bronchiolitis caused by respiratory syncytial virus

目的 探讨肌肉注射基因重组干扰素γ (rIFN γ)对呼吸道合胞病毒 (RSV)感染毛细支气管炎患儿的临床治疗效果。方法 采用双盲、随机对照方法 ,对诊断为RSV感染阳性、符合纳入标准的 39例毛细支气管炎患儿进行了rIFN γ的治疗研究。观察了治疗前、后症状好转及实验室指标如细胞免疫指标 ,血清总IgE等的恢复情况。结果 (1)治疗前RSV感染毛细支气管炎患儿存在较低的CD+ 8水平 (2 5± 7) (P <0 .0 5 )和较高的血清总IgE水平 (0 .5 1～ 84kIU/L) (P <0 .0 1)。(2 )rIFN γ治疗组在临床Lowell评分降低、咳嗽消失、发热降至正常等方面所需天数比生理盐水对照组明显缩短 ,差异均有显著意义 (P <0 .0 1、0 .0 5 ) ;但细胞免疫指标和血清总IgE水平无明显改善 (P >0 .0 5 )。结论 (1)RSV感染毛细支气管炎患儿存在Th2型增强的免疫反应 ;(2 )rIFN γ治疗婴幼儿RSV感染毛细支气管炎是较为有效的方案。

Objective To evaluate the therapeutic effects of intramuscular injection of recombinant interferon gamma (rIFN γ) in treatment of acute bronchiolitis in infants caused by respiratory syncytial virus (RSV). Methods 1. The authors compared the RSV infected bronchiolitis infants with the normal children in terms of cellular immunology parameters and total serum IgE antibodies. 2. The authors applied double blind, randomized, controlled method to conduct the prospective clinical study in 39 infants with bronchiolitis caused by RSV infection and compared the effects of rIFN γ on remission of acute phase symptoms, cellular immunology parameters and total serum IgE antibodies. The rIFN γ group had 20 cases and placebo (normal saline,N.S.) group had 19 cases. Results 1. The mean level of serum total IgE antibodies was much higher (0.51～84 k IU/L) in infants with bronchiolitis caused by RSV than those in normal children (P<0.01). The CD + 3 (48±14 P<0.01), CD + 4(24±10 P<0.01), and CD + 8 (25±7 P<0.05) T cell number of the former group was much lower compared with those of the normal children; 2. Treatment with rIFN γ was superior to N.S. treatment in terms of the improvement of clinical Lowell's scores especially on days 3 ,5 ,7 (P<0.01), the number of days needed for relieves of symptoms and signs such as cough (P<0.01), fever (P<0.05) and wheezing (P<0.01) (5.2±1.2, 4.4±1.7 and 2 days, respectively). 3. No improvement of CD + 3, CD + 4, CD + 8, B cell number and the mean level of the total serum IgE antibodies (P>0.05) was found in both groups. 4. No severe side effects were seen in rIFN γ group except for 1 case with low degree fever and 1 case with rash during the treatment. The total white blood cell counts remained almost the same in the two groups (t=0.48 P>0.05), and were both more than 6.0×10 9/L. Conclusions 1. Compared with the normal controls, infants infected with RSV had decreases in the number of CD + 8(P<0.05) T cell and an increase in the level of total serum IgE antibodies. These findings suggested a predominant Th2 like response in RSV infected bronchiolitis infants. 2. The intramuscular injection of rIFN γ was demonstrated to be a safe and effective therapeutic approach to infants with bronchiolitis caused by RSV.