大剂量静脉注射用免疫球蛋白治疗小儿重症病毒性脑炎的临床疗效观察

Clinical observation of high-dose intravenous immunoglobulin gamma globulin in the treatment of children with severe viral encephalitis

目的探讨大剂量静脉注射用免疫球蛋白(IVIG)治疗小儿重症病毒性脑炎(SVE)的临床疗效。方法采用回顾分析法,对2012年5月至2013年8月于首都儿科研究所附属儿童医院接受IVIG治疗的34例SVE患儿的临床病历资料为研究对象。根据治疗方法的不同,将其分为观察组(n=17),采取SVE常规治疗+大剂量IVIG[(400mg/(kg·d)]×5d治疗,对照组(n=17),采取SVE常规治疗+普通剂量IVIG[(200mg/(kg·d)×5d]治疗。对两组患儿主要症状、体征消失时间,脑电图、脑脊液恢复正常的时间及其住院时间、临床治疗效果进行统计学分析。对两组患儿进行血常规及肝、肾功能监测,分析不良反应发生情况。本研究遵循的程序符合首都儿科研究所附属儿童医院人体试验委员会制定的伦理学标准,得到该委员会批准。两组患儿年龄、性别及SVE常规治疗方案等一般临床资料比较,差异均无统计学意义(P>0.05)。结果治疗后,观察组患儿发热、昏迷、惊厥消失时间及平均住院时间,脑电图和脑脊液恢复正常的时间,均显著短于对照组,差异均有统计学意义(P<0.05)。观察组总有效率为94.11%(16/17),显著高于对照组的64.71%(11/17),差异亦有统计学意义(P<0.05)。对两组患儿进行血常规及肝、肾功能监测结果显示,仅对照组出现2例白细胞计数减少,出院1个月后复查均恢复正常;观察组1例出现面红、皮肤瘙痒,减慢IVIG输注速率,疗程结束后自行消失。除此之外,两组患儿均无其他指标及器官功能异常发生。结论大剂量IVIG治疗SVE可迅速改善患儿的临床症状,缩短病程,而且仅出现轻微不良反应。

Objective To observe effect of high dose intravenous immunoglobulin gamma globulin （IVIG） in treatment of children with severe viral encephalitis （SVE）. Methods Retrospective analytical method study was used on the clinical data of 34 cases of SVE patients in Capital Institute of Pediatrics Affiliated Children＇s Hospital from May 2012 to August 2013, they were divided into observation group （71 17）, take conventional treatment ＋ high dose IVIG E400 mg/ （kg·d）×5 d] treatment, and control group （n=17）, take conventional treatment ＋ IVIG [（200 mg/ （kg·d） ×5 d）] treatment according to different treatment methods. The main clinical symptoms and signs disappeared time, electroencephalogram （EEG）, cerebrospinal fluid （CSF） recovery time, hospitalization time and clinical therapeutic effect between two groups were analyzed by statistical methods. Analyzed occurrences of adverse reactions on two groups by blood routine and liver, kidney function monitoring of children. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Capital Institute of Pediatrics Affiliated children＇s Hospital. Informed consent was obtained from the parents of each participant. There were no significant differences between two groups among age, gender and convention therapeutic schedules ere （P〈0.05）. Results After therapy by different doses of IVIG, the fever, coma, convulsions disappeared time, the average hospitalization time, EEG and CSF recovery time in observation group were significantly shorter than those in control group, and there were significant differences （P〈0.05）. The total effective rate ofobservation group was 94.11% （16/17）, it was significantly higher than that in control group of 64.71% （11/17）, and there was significant difference （P〈0.05）. Monitoring results of blood routine and liver, renal function of children in two groups showed that only 2 cases of white blood cell counts decreased in control group, which were significantly lower than normal levels, but they returned to normal 1 month after discharge. There were no other clinical data and abnormal function of organs in two groups of children. Conclusions High dose IVIG in treatment of children with SVE can not only rapidly improve the clinical symptoms of SVE, shorten the course of SVE, but also the risks of adverse reactions are very slight.