丙种球蛋白对特发性血小板减少性紫癜患儿相关细胞因子的影响及临床结局评价

Effect of gamma globulin on related cytokines in children with idiopathic thrombocytopenic purpura and evaluation of its clinical outcomes

目的研究丙种球蛋白（HD—IVIG）对特发性血小板减少性紫癜（ITP）患儿相关细胞因子的影响，并评价其临床结局。方法选取2014年1月至2015年10月收治64例ITP患儿，将其随机分为对照组和观察组，各32例。对照组采用糖皮质激素治疗方案，观察组在对照组基础上，静脉滴注HD—IVIG治疗，维持5d，个体化剂量确定为0．2g／（kg·d）或0．4g／（kg·d）。比较两组相关细胞因子[白介素-2（IL-2）、肿瘤坏死因子-α（TNF-α）、干扰素-α（IFN-α）1变化和临床疗效，进一步比较观察组HD—IVIG不同剂量患儿的治疗效果。结果两组治疗后IL-2、TNF-α、IFN—OL较治疗前均显著下降（P〈0．05），观察组治疗后上述指标分别较对照组低，差异均有统计学意义（P〈0．05）；观察组治疗总有效率96．88％，对照组78．13％，差异统计学意义（P〈0．05）；中小剂量[0．2g／（kg·d）]、大剂量[0．4g／（kg·d）]HD—IVIG治疗在出血控制时间、血小板增高值方面相比较，差异无统计学意义（P〈0．05）。结论HD-IVIG能有效降低ITP患儿免疫相关细胞因子IL-2、TNF—α、IFN—α的表达水平，提高血小板含量和控制出血症状，且中小剂量和大剂量HD—IVIG效果并无明显区别。

Objective To study the effect of gamma globulin （HD-IVIG） on related cytokines in children with idiopathic thrombocytopenic purpura （ITP） and to evaluate its clinical outcomes. Methods 64 children with ITP treated from January, 2014 to October, 2015 were randomized into a control group and an observation group, 32 cases for each group. The control group were treated with glucocorticoid; in addition, the observation group were treated with intravenous infusion of HD-IVIG for 5 days. The individual dose was 0.2 g/（kg-d） or 0.4 g/（kg.d）. The changes of related cytokines [interleukin-2 （IL-2）, tumor necrosis factor-alpha （TNF-α）, and interferon- alpha （IFN-α）] and clinical curative effect were compared between these two groups. The therapeutic effects in children treated with different doses of IVIG-HD in the observation group were further studied. Results The IL- 2, TNF-α, and IFN-α were significantly lower after than before treatment in both groups （P〈0.05） and were in the observation group than in the control group after treatment （P〈0.05）. The total response rate was higher in the observation group than in the control group （96.88% vs. 78.13%, P〈0.05）. There were no statistical differences in bleeding control time and added value ofplatelet between the small or medium doses [0.2 g/（kg-d）] group and the large dose [0.4 g/（kg-d）] group （P〈0.05）. Conclusions HD -IVIG can effectively reduce the expression levels of immune related cytokines （IL-2, TNF-α, and IFN-α） in children with ITP, improve the platelet content, and control the bleeding symptoms. Besides, there is no significant difference between small or medium doses and large dose of HD-IVIG.