更昔洛韦联合干扰素-α1b雾化吸入治疗儿童传染性单核细胞增多症的疗效

Curative effect of Ganciclovir combined with interferon -α1b inhalation in treating children with infectiousmononucleosis

目的探讨更昔洛韦联合干扰素-α1b雾化吸入治疗儿童传染性单核细胞增多症（IM）的临床疗效和安全性。方法选取IM患儿177例，采用随机数字表法分为3组，每组59例，分别选用更昔洛韦静脉滴沣（A组）、更昔洛韦静脉滴注＋f扰素-α1b雾化吸入（B组）和更昔洛韦静脉滴注＋干扰素-α1b肌肉注射（c组）3种治疗方法治疗5～7d。比较各组患儿用药后热退时间、咽峡炎好转时间、异型淋巴细胞〈0．05时间、颈部淋巴结缩时间、肝回缩时间、脾回缩时间及治疗前后EB病毒（EBV）-DNA拷贝数和T淋巴细胞亚群；同时观察治疗过程中各组出现的不良反应。结果与A组比较，B组、C组在热退时间[（3．20±1．81）d、（3．17±1．76）d比（4．（11±2．34）d]、咽峡炎好转时间[（3．15±1．33）d、（3．09±1．37）d比（3．98±1．31）d]、异型淋巴细胞〈0．05时间[（3．12±1．55）d、（3．10-4-1．33）d比（3．95±1．26）d]明显缩短，差异均有统计学意义（F：4．150、4．580、4．060，均P〈0．05），治疗7d后EBV—DNA阴转率均高于A组[53例（89．8％）、52例（88．1％）比41例（69．5％），x2=10．403，P〈0．05]，在治疗后7d细胞免疫功能的恢复上差异明显[CD3＋：（63．00±4．39）％、（62．75±4．84）％比（68．70±7．70）％，CD4＋：34．08（30．21，41．70）％、33．94（29．17，45．17）％比32．34（28．16，43．53）％，CD8＋30．59（27．14，40．22）％、30．09（27．54，40．48）％比32．57（28．68，41．17）％，CIM＋／CD8＋1．12（1．03，1．31）、1．11（0．99，1．64）比0．94（0．87，1．59），F/x2=11．020、1．217、1．121、6．728，均P〈0．05]。B组和C组间比较各项指标变化差异不明显，差异均无统计学意义（均P〉0．05）。小良反应方面：C组出现2例发热，每组均出现2例粒细胞减少。结论更昔洛韦联合干扰素-α1b雾化吸入治疗儿童IM有良好疗效，可改善临床症状，促使细胞免疫功能改善及血EBV—DNA转阴。不良反应少且无疼痛，易为患儿及家长所接受，故推荐更昔洛韦联合下扰素-α1b雾化吸入治疗儿童IM。

Objective To investigate the clinical efficacy and safety of Ganciclovir combined with interferon -α1b inhalation for children with infectious monouucleosis（IM）. Methods A total of 177 childhood cases of IM were selected,and they were divided into 3 groups,59 cases in each group according to the random number table. Three the- rapeutic methods were applied in different groups for 5 - 7 days in different groups ： Ganciclovir （ group A ） , Gancielovir ± interferon- a l b inhalation （group B） and Ganeiclovir ± interferon-α1b intramuscularly （group C）. The time of post - drug recovery from isthmitis, less than 0.05 of heterotypic lymphocytes, shrink of cervical lymph nodes shriuk,liver retraction,spleen retraction among groups were compared. The Epstein - Barr virus （EBV） - DNA copy number and T lymphocyte subsets were compared before and after treatment. Adverse reactions were observed in each group. Results Compared with group A, the time to defervescence [ （3.20 ± 1.81 ） d, （3. 17 ± 1.76） d vs. （4.01 ± 2.34） d ,duration of isthmitis was （3.15 ± 1.33 ） d, （3.09 ± 1.37） d vs. （3.98 ± 1.31 ） d] ,and the time of heterotypic lymphocytes less than 0.05 [ （3.12 ± 1.55 ） d, （3.10 ± 1.33 ） d vs. （ 3.95 ± 1.26） d ] in group B and group C, were obvious shorter, and there were significant differences （F = 4. 150,4. 580,4. 060, all P 〈 0.05 ）. EBV - DNA negative conversion rate of group B and group C were higher than that of group A [53 cases（ 89.8% ） ,52 cases （88. 1% ） vs. 41 cases （ 69.5% ） ,X2 = 10. 403, P 〈 0.05 1 , and the cellular immune function was improved signi- ficantly than that of group A afler treatment for 7 days [ CD3 ± ： （63.00 ± 4.39 ） % , （ 62.75 ± 4.84 ） % vs. （ 68.70 _± 7.70）% ;CD4± ：34.08（30.21,41.70）% ,33.94（29. 17,45.17）% vs. 32.34（28. 16,43.53）% ;CD8± ：30.59 （27.14,40.22）%,30.09（27.54,40.48）% vs. 32.57（28.68,41.17）%;CD4±/CD8±：1.12（l.03,1.31）,1.11 （0.99,1.64） vs. 0.94 （ 0.87,1.59 ）, F/X2 = l 1. 020,1.217,1.121,6. 728, all P 〈 0.05 ）. The differences in indexes between B group am] C group were not significant, and there was no statistical significance （ all P 〉 0.05 ）. There were 2 cases with fver in the group C,and 2 cases of granulocytopenia in all group. Conclusions Ganciclovir combined with interfhron- crib inhalation or bltramnscular injection is effective and safe in treating children with IM. It canimprove clinical symptoms, cellular immune function and EBV - DNA negative conversion rate. Since inhalation is of less side effects and no pain, it can be accepted by children and their parents easily. Therefore, it is recommended that Ganciclovir be used together with interferon -ctlb inhalation in the treatment of children with IM.