更昔洛韦分别联合神经节苷脂和丙种球蛋白治疗小儿病毒性脑炎的临床疗效研究

Clinical effects of ganciclovir combined with gangliosides and gamma globulin in treating children with viral encephalitis

目的对比更昔洛韦分别联合神经节苷脂和丙种球蛋白治疗小儿病毒性脑炎的临床效果及安全性。方法选取2010年1月—2015年12月收治的124例小儿病毒性脑炎患者,随机分为观察1组(42例)、观察2组(43例)及对照组(39例)。观察1组给予更昔洛韦联合神经节苷脂治疗,观察2组给予更昔洛韦联合丙种球蛋白治疗,对照组单纯给予更昔洛韦治疗,比较3组患者临床疗效,血清神经元特异性烯醇化酶(NSE)及炎症因子水平。结果观察1组的总有效率为95.24%,观察2组的总有效率为93.02%,均显著高于对照组的总有效率(79.48%);观察组(1、2)的头痛、发热、惊厥、意识模糊、脑膜刺激征、脑脊液异常等临床症状消失时间以及住院天数均显著短于对照组(P<0.05);观察1组在惊厥、意识模糊消失时间上显著短于观察2组。治疗后,3组患者血清中NSE水平均较治疗前明显降低(P<0.05),且观察组(1、2)患者血清NSE水平显著低于对照组(P<0.05);观察1组的NSE水平与正常对照组无差异;观察2组的NSE水平显著高于正常组(P<0.05)。3组患者血清中白介素6(IL-6)、白介素1β(IL-1β)的水平均较治疗前明显降低(P<0.05),且观察组(1、2)患者血清炎症因子水平明显低于对照组(P<0.05)。结论更昔洛韦联合神经节苷脂和更昔洛韦联合丙种球蛋白两种方案均是治疗小儿病毒性脑炎的有效措施,均能有效降低机体炎症反应,更昔洛韦联合神经节苷脂具有更好的修复神经损伤的功效,值得临床推广。

Objective To compare the clinical effect and safety evaluation of three different dose regimens for treating children with viral encephalitis. Methods Totally 126 cases treated in Xi＇an Central Hospital from January 2010 to December 2015 were randomly divided into observation group 1 （ganciclovir combined with gangliosides, 42 cases）, observation group 2 （ganciclovir combined with gamma globulin, 43 cases）, and control group （39 cases）. The clinical effect and levels of NSE, inflammatory cytokine were compared in the three groups. Results The total effective rate in observation group 1 was 95.24% and that of observation group 2 was 93.02%, which were significantly higher than that of control group （79.48%）. The disappearance time of headache, fever, convulsions, clouding of consciousness, meningeal irritation sign, cerebrospinal fluid abnormalities, and length of stay in observation groups （both 1 and 2） were significantly shorter than those in control group （P 〈 0.05）; After therapy, the levels of NSE in three groups were obviously decreased compared with those before therapy （P 〈 0.05）, and those in observation group were significantly lower than the control group （P 〈 0.05）; the levels of inflammatory cytokine in all three groups were obviously decreased compared with those before therapy （P 〈 0.05）, and that of observation group 1 had no statistical difference with the normal group, whereas that in control group was significantly higher than the normal group （P 〈 0.05）. Conclusion Ganciclovir combined with gangliosides as well as ganciclovir combined with gamma globulin were both effective methods in treating children with viral encephalitis and could decrease levels of inflammatory cytokine. Ganciclovir combined with gangliosides could effectively repair nerve damage, which deserves clinical expansion.