口服免疫球蛋白对轮状病毒肠炎患儿肠道SIgA分泌的影响

Effect of Ingested Immunoglobulin on SIgA Expression in Pediatric Rotavirus Enteritis

目的了解口服免疫球蛋白对儿童轮状病毒肠炎的临床疗效,探究其对患儿肠道自身分泌型IgA(SIgA)生成的影响。方法纳入本院确诊的轮状病毒肠炎患儿100例,采用随机对照试验方法分为两组(对照组和口服免疫球蛋白组),每组50例患儿。在口服蒙脱石散和补液等基本治疗的基础之上,对照组予安慰剂口服,免疫球蛋白组予"抗轮状病毒鸡卵黄IgY"口服治疗。于治疗第1、3、5、7、9、11d收集患儿大便,定期记录临床症状。采用放射免疫法定量检测大便SIgA水平,双抗体夹心酶联免疫法半定量检测大便轮状病毒排泄量。结果治疗1d后,口服免疫球蛋白组患儿腹泻频次较对照组明显减轻(P<0.05)。口服免疫球蛋白组病程为(4.5±0.92)d,对照组为(5.8±1.68)d,两组差异有统计学意义(P=0.015)。口服免疫球蛋白组患儿大便中SIgA含量在各时间点均高于对照组(P<0.05),口服免疫球蛋白组大便SIgA含量倍增时间在第3d,对照组在第5d。口服免疫球蛋白组的大便轮状病毒排泄量在各时间点均低于对照组(P<0.05)。结论口服免疫球蛋白能促进机体自身SIgA生成,有益于肠道内轮状病毒的清除,从而快速缓解轮状病毒肠炎临床症状,缩短病程。

Objective To identify the effects of ingested anti-rotavirus immunoglobulin on enteric expressions of SIgA in pediatric rotavirus enteritis. Methods In this randomized, placebo controlled clinic trial, 100 patients of pediatric rotavirus enteritis who simultaneously received fluid replacement as basic therapy, were randomly divided into control and immunoglobulin treated groups. The patients in experimental group were given ＂ingested anti- rotavirus IgY＂. Stool sample was collected at day 1, 3, 5, 7, 9 and 11, the level of fecal SIgA was quantifies by radioimmunoassay kit, and fecal rotavirus shedding was detected by double-sandwich ELISA. Results The frequency of diarrhea in immunoglobulin group was obviously less than that in control group （P〈0.05）. The mean course of diarrhea was （4.5±0.92） d in immunoglobulin group, and （5.8±1.68） d in control group （P=0. 015）. The fecal SIgA level in immunoglobulin group was higher than that in control group（P〈0. 05）. The doubling time of SIgA level was the 3rd d in immunoglobulin group, and the 5th d in control group. The fecal rotavirus shedding in immunoglobulin group was obviously lower than that in control group （P〈 0. 05）. Conclusion Ingested anti- rotavirus immunoglobulin could promote the expression of enteric SIgA to remove rotavirus, achieving the benefit to release diarrhea in pediatric rotavirus enteritis.