不同剂量人免疫丙种球蛋白辅助治疗小儿重症肺炎的临床疗效分析

Clinical efficacy of children with severe pneumonia treated by different doses of human immune gamma globulin

目的观察不同剂量人免疫丙种球蛋白辅助治疗小儿重症肺炎的临床疗效。方法收集小儿重症肺炎93例,按照治疗方案的不同将入组患者分为三组,A组采用基础治疗+大剂量人免疫丙种球蛋白(1g/kg.d),B组采用基础治疗+小剂量人免疫丙种球蛋白(400mg/kg.d),C组采用基础治疗+等量安慰剂,比较三组患者总体治疗疗效;对比三组患者症状消失及住院时间;比较三组患者治疗前后免疫球蛋白及T细胞亚群水平变化;观察三组患者不良反应发生情况。结果 A组治疗总有效率(93.55%)明显高于B组(80.65%)、C组(77.42%),差异均有统计学意义(P<0.05);A组气促、咳嗽、啰音消失时间,体温稳定时间及住院时间均明显短于B、C组,差异均有统计学意义(P<0.05)。治疗后A组IgG水平明显高于B、C两组,明显高于治疗前,差异有统计学意义(P<0.05)。治疗后A组CD_4^+、CD_4^+/CD_8^+均明显高于B、C组,明显高于治疗前,CD_8^+明显低于B、C组,明显低于治疗前,差异均有统计学意义(P<0.05)。A、B、C三组患者均无严重不良反应。结论大剂量人丙种免疫球蛋白可在一定程度上增强患者免疫力,可有效缓解小儿重症肺炎患者症状,缩短治疗周期。

Objective To observe the clinical efficacy of children with severe pneumonia treated by different doses of human immune gamma globulin. Methods 93 children with severe pneumonia from March 2014 to March2015 in our hospital were collected,and they were divided into three groups based on treatment methods. The group A was given basic treatment ＋ high dose of immune globulin（ 1 g/kg. d）,the group B was given basic treatment ＋ lowdose human immune gamma globulin（ 400 mg/kg. d）,and the group C was given placebo. Their overall efficacy,symptoms and hospital stay were compared among the three groups. The changes of immunoglobulin and T cell levels in the three groups were observed before and after treatment. Adverse events of the three groups were recorded. Results The overall efficiency of the group A（ 93. 55%） was significantly higher than the group B（ 80. 65%） and C（ 77. 42%）（ P〈0. 05）. The disappeared time of shortness breath,cough,rales,the time of temperature stabilization and the duration of hospital stay were significantly shorter in the group A than in the group B and C（ P〈0. 05）.The level of Ig G was significantly higher in the group A than in the group B and C after treatment（ P〈0. 05）. The levels of CD4^＋ and CD4/CD8 in the group A were significantly higher than those in the group B and C after treatment（ P〈0. 05）. There was no severe adverse events occurred in the three groups. Conclusion The high dose of gamma immunoglobulin can enhance immunity of patients,effectively alleviate the symptoms of children with severe pneumonia patients,and shorten the treatment period.