狂犬病免疫球蛋白应用研究进展

Advances in Application of Rabies Immunoglobulin

中国是全球第二大狂犬病流行国家,每年有数以百万计的狂犬病Ⅲ级暴露案例需要联合应用狂犬病免疫球蛋白和狂犬病疫苗。狂犬病免疫球蛋白价格较昂贵,使用方法较复杂,在狂犬病Ⅲ级暴露后处置中使用率长期以来偏低。降低狂犬病免疫球蛋白的使用剂量可以减少狂犬病Ⅲ级暴露后处置费用。简化狂犬病免疫球蛋白的使用方法可以使狂犬病Ⅲ级暴露后处置更加便于实施。降低狂犬病免疫球蛋白的使用剂量和简化狂犬病免疫球蛋白的使用方法有助于提高狂犬病Ⅲ级暴露后处置中狂犬病免疫球蛋白的使用率。狂犬病免疫球蛋白对狂犬病疫苗免疫效果的影响研究中存在矛盾的结论,探索狂犬病免疫球蛋白影响狂犬病疫苗免疫效应的机制有助于解释狂犬病免疫球蛋白对狂犬病疫苗免疫效果影响的复杂性。本文系统回顾关于狂犬病免疫球蛋白应用研究的进展,以期为制订新的具备实际操作可行性的狂犬病免疫球蛋白应用准则提供参考。

China has the second highest number of rabies cases worldwide.There are millions of categoryⅢrabies exposure cases in China every year,which are treated with rabies immunoglobulin（RIG）and the rabies vaccine.The price of RIG is relatively expensive,and the application of RIG is relatively complicated.The rate of RIG use in post exposure prophylaxis（PEP）for rabies exposure category Ⅲ cases has remained low for a significant amount of time.Reducing the dosage of RIG could reduce the cost of PEP,while simplifying the use of RIG could make PEP easier.Together,these steps could improve the rate of RIG utilization in PEP.There are conflicting conclusions in studies of RIG on the immune effects of the rabies vaccine.Exploring the mechanism of action of RIG in the immune response to the rabies vaccine would help to explain the role of RIG in the immune effects mediated by the rabies vaccine.In this paper,the progress of research on the application of RIG is systematically reviewed in order to provide a reference for the formulation of new and more practical guidelines for the application of RIG.