静脉注射人免疫球蛋白治疗重型肝炎的临床研究

Clinical treatment of the severe hepatitis with intravenous human immunoglobulin

目的探讨治疗重型肝炎(SH)的有效药物,研究静脉注射人免疫球蛋白(IVIG)治疗SH的临床价值,评估其安全性。方法 62例SH患者分为治疗组(30例)和对照组(32例)。对照组给予卧床休息、能量补充、调节水电解质平衡、保肝、血浆蛋白支持等综合治疗。治疗组在此基础上给予IVIG静脉注射,5 g/次,1次/d,共5 d。治疗前和治疗后分别检测两组患者的血常规、尿常规、便常规,应用全自动生化分析仪检测肝肾功能、心肌酶、血生化;应用普利生全自动血凝仪检测凝血4项指标(PT、APTT、TT和FIB)。观察时间最长6周,对生存病例随访3个月。结果治疗后两组患者在血生化学方面(TBil、PT、PA和CHE),经比较后差异具有统计学意义(P均<0.05)。治疗组30例患者中有效24例,有效率为80.00%;对照组32例患者中有效12例,有效率为37.50%,两组差异具有统计学意义(P<0.01)。不良反应:治疗组出现1例胸闷、轻度气短不适,经对症处理后症状消失,不良反应发生率为3.33%。结论应用IVIG治疗多种原因引起的SH,可以有效改善SH患者的血生化指标,显著提高SH患者的存活率,降低其病死率,且不良反应轻微,是SH安全、有效的治疗手段。

Objective To investigate the effective drug for the treatment of various reasons severe hepatitis and study the clinical value of human intravenous immunoglobulin （IVIG） in the treatment of severe hepatitis, assess security of IVIG drug. Methods Among 62 patients with severe hepatitis, the treatment group and the control group were composed by 30 and 32 patients, respectively. The control group was treated with rest, energy supplement, regulate water electrolyte and acid-base balance, the hepatoprotective, plasma, protein, comprehensive treatment. The treatment group was given IVIG intravenous on the basis of the control group, each 5 g, once a day for five times. Before and after treatment, the routine of blood, urine and stool were tested. The liver and kidney function, cardiac enzymes, blood biochemistry were detected by automatic biochemical analyzer. The cruor four kinds of projects （PT, APTT, TT and FIB） were detected by automatic coagulation analyzer. The above indicators observation time was six weeks. Survived cases were followed up for 3 months. Results After treatment, the two groups were with significant differences at blood biochemistry （TBil, PT, PA and CHE） （P all 〈 0.05）. In treatment group, there were 24 cases were effective, with the efficiency of 80.00%. In control group, there were 12 cases were effective, with the efficiency of 37.50%. The efficiency in the two groups was with significant differences （P 〈 0.01）. The improvement rate of the treatment group significantly higher than that of control group. Adverse reactions： in treatment group there was one case with chest tightness, mild shortness of breath, symptoms disappeared after symptomatic treatment, accounting for 3.33%. Conclusions IVIG treatment of various reasons severe hepatitis is effective, a variety of biochemical indicators of severe hepatitis patients can improve. Followed up for 3 months, IVIG significantly improved healing rate of patients with severe hepatitis. Adverse reactions are rare and mild. IVIG is effective and security drug for the treatment of severe hepatitis.