摘要
①目的 探讨静脉注射大剂量人体丙种球蛋白 (IVIG)对儿童重症病毒性脑炎 (SVE)预后的影响。②方法 将 5 6例SVE病儿随机分为常规组 (n =2 2 ,给予抗病毒、降颅压、止惊、冬眠疗法、加压氧和糖皮质激素等常规治疗 )和IVIG组 (n =34,在常规治疗基础上尽量在 7d内给予IVIG ,剂量为每天 4 0 0~ 6 0 0mg/kg体质量 ,共2~ 3d) ,比较两组病儿治疗后的近期和远期预后 ,测定两组治疗前后血浆白细胞介素 6 (IL 6 )、肿瘤坏死因子 α(TNF α)水平并与对照组进行比较。③结果 与常规组比较 ,IVIG组治疗过程中呼吸衰竭、消化道出血、院内感染的发生率和病死率明显降低 (χ2 =6 .5 10~ 13.86 0 ,P <0 .0 5 ,0 .0 1) ;病后遗留脑性瘫痪者明显减少 (χ2 =4 .0 2 7,P <0 .0 5 ) ;病后 3,6 ,12个月IVIG组除瘫痪外 ,癫痫、脑影像学损害、脑电图和脑干听觉诱发电位异常者均明显减少 (χ2 =6 .4 5 1~ 4 5 .5 81,P <0 .0 5 ,0 .0 1) ;病后 6 ,12个月IVIG组的言语智商和总智商较常规组明显高 (t =2 .0 81~ 3.4 13,P <0 .0 5 ,0 .0 1)。IVIG组在病后 3,6个月时血浆IL 6 (15 .1,7.5ng/L)和TNF α(2 0 .4 ,11.8ng/L)水平较对照组 (4.2 ,8.5ng/L)明显升高 (z =- 3.337~ - 3.899,P <0 .0 1) ,但病后 12个月时血浆IL 6和TNF ?
Objective\ To explore the effects of high dose intravenous immunoglobulin therapy (IVIG) on prognosis in children with severe viral encephalitis (SVE). \ Methods\ Fifty six children with SVE were randomly divided into two groups: Routine Group and IVIG Group. For Routine Group( n =22), routine treatment was given,including antiviral, lowering intracranial pressure, anticonvulsive, hibernation, hyperbaric oxygenation, etc.; for IVIG Group( n =34), IVIG was given at a dose of 400- 600 mg/(kg·day) for two to three days on the basis of routine treatment within one week as possible. The early and late progneses of children with SVE were studied; the plasma interlukin 6 (IL 6) and tumor necrosis factor alpha (TNF α) levels were measured before and after the treatment. \ Results\ After IVIG treatment, the mortality, the incidence of respiratory failure, hemorrhage of digestive tract, and hospital infection decreased markedly in IVIG Group compared with those in Routine Group( χ 2= 6.510 - 13.860 , P <0.05,0.01); the number of children with cerebral palsy reduced significantly in IVIG Group( χ 2=4.027,P< 0.05);the numbers of children with epilepsy, abnormal electroencephalogram, and brain stem auditory evoked potentials and with the brain image impairment, 3, 6 and 12 months after the onset of the sickness reduced significantly in IVIG Group ( χ 2= 6.451 - 45.581 ,P < 0.05,0.01). The speech IQ and total IQ after 6 months and 12 months of sickness in IVIG Group increased markedly compared to those in Routine Group( t=2.081-3.413,P <0.05,0.01). The plasma IL 6 (15.1, 7.5 ng/L) and TNF α(20.4, 11.8 ng/L) levels in IVIG Group in 3 and 6 months after the onset were still higher than those for the control group (4.2 and 8.5 ng/L) ( z=-3.337--3.899,P <0.01), but returned to the levels of the control group 12 months after the onset. The plasma IL 6 and TNF α levels in IVIG Group were lower than those of Routine Group 3 months after the onset( z=-4.435- -5.348 , P< 0.01 ), but were higher than those of Routine Group 6 months after the onset ( z=-2.675,-2.836, P < 0.01), and no difference was found between IVIG Group and Routine Group 12 months after the onset( z=-0.167,-1.445, P > 0.05). \ Conclusion\ IVIG can improve the prognosis of children with SVE; the mechanism may be related to IVIG block of immunopathological injury and the effects of nutrition repair of low IL 6 and TNF α levels.
出处
《青岛大学医学院学报》
CAS
2002年第3期196-199,共4页
Acta Academiae Medicinae Qingdao Universitatis
基金
青岛市科委科研基金资助课题 (K2 15 /2 0 0 3 )