不同剂量丙种球蛋白治疗小儿川崎病的疗效及对炎症因子和免疫功能的影响

Effects of different doses of gamma globulin in children with Kawasaki disease and their influences on inflammatory factors and immune function

目的探讨不同剂量丙种球蛋白在川崎病患儿中的临床治疗效果及对炎症因子、免疫功能的影响。方法选择2016年1月至2018年1月入院治疗的川崎病患儿120例,所有患儿均采用丙种球蛋白进行治疗,根据丙种球蛋白的使用剂量分为小剂量组(n=60)和大剂量组(n=60)。小剂量组予以小剂量丙种球蛋白分次给药治疗[丙种球蛋白0.4 g/(kg·d)],大剂量组给予大剂量丙种球蛋白单次给药(丙种球蛋白2 g/kg),两组均进行15 d的治疗,治疗后对患儿的治疗效果进行评估。记录两组患儿发热、颈淋巴结肿胀、黏膜弥漫性充血、躯干红斑、结膜充血的缓解时间;记录两组治疗前、治疗15 d后PCT、CRP、TNF-α和IL-6水平;记录两组治疗前、治疗15 d后CD3^+、CD4^+、CD8^+水平及CD4^+/CD8^+;记录并统计两组治疗15 d后恶心呕吐、腹泻、皮疹、头晕头痛的发生情况。结果大剂量组发热、颈淋巴结肿胀、黏膜弥漫性充血、躯干红斑、结膜充血缓解时间均短于小剂量组,差异均具有统计学意义(P<0.05);治疗后,两组PCT、CRP、TNF-α和IL-6水平均显著降低,且大剂量组均明显低于小剂量组,差异均具有统计学意义(P<0.05)。治疗后,两组CD3^+、CD4^+水平及CD4^+/CD8^+均显著升高,CD8^+水平显著均降低(P<0.05),且大剂量组CD3^+、CD4^+水平及CD4^+/CD8^+均高于小剂量组,CD8^+水平低于小剂量组,差异均具有统计学意义(P<0.05);大剂量组患儿恶心呕吐、腹泻、皮疹、头晕头痛的发生率与小剂量组比较,差异均无统计学意义(P>0.05)。结论大剂量丙种球蛋白用于小儿川崎病的治疗中有助于缩短患儿症状改善时间,药物安全性较高,更加有助于降低炎症因子水平,且能提高患儿免疫水平,值得推广应用。

Objective To investigate the clinical treatment effects of different doses of gamma globulin in children withKawasaki disease and its effects on inflammatory factors and immune function. Methods One hundred and twenty childrenwith Kawasaki disease admitted in our hospital from January 2016 to January 2018 were selected. All children were treatedwith gamma globulin. They were divided into low dose group （n=60） and large dose group （n=60） according to the dose ofgamma globulin. The low dose group was treated with low dose gamma globulin in divided dose [0.4 g/（kg· d） of gammaglobulin], the large dose group was treated with large dose gamma globulin in single dose （2 g/kg of gamma globulin）. Thetwo groups were treated for 15 days. The effects of treatment were evaluated after treatment. The relief time of fever, necklymph node swelling, diffuse mucosal congestion, erythema of the trunk and conjunctival hyperemia in the two groups wererecorded. The levels of PCT, CRP, TNF-α and IL-6 in the two groups before and after 15 d of treatment were recorded.The levels of CD3＋, CD4＋and CD8＋, CD4＋/CD8＋in the two groups before and after 15 d of treatment were recorded. Theoccurrence of nausea and vomiting, diarrhea, rash and dizziness headaches after 15 d of treatment were recorded andstatisticsd. Results The relief time of fever, neck lymph node swelling, diffuse mucosal congestion, erythema of the trunk,and conjunctival hyperemia in the large dose group were shorter than those in the low dose group, the differences werestatistically significant （P〈0.05）. After treatment, the levels of PCT, CRP, TNF-α and IL-6 in the two groups significantlydecreased, and those in the large dose group were significantly lower than the low dose group, the differences werestatistically significant （P〈0.05）. After treatment, the levels of CD3＋and CD4＋, CD4＋/CD8＋in the two groups significantlyincreased, CD8＋level in the two groups significantly decreased, and levels of CD3＋and CD4＋, CD4＋/CD8＋in the large dosegroup were higher than those in the low dose group, CD8＋level in the large dose group was lower than that in the low dosegroup, the differences were statistically significant （P〈0.05）. There were no significant differences in the incidences ofnausea, vomiting, diarrhea, rash and dizziness headache between the large dose group and the low dose group （P〉0.05）.Conclusion The use of large dose of gamma globulin in children with Kawasaki disease can help shorten the time for symptom improvement, and the safety of drug is higher. It is more helpful to reduce the levels of inflammatory factors, andcan improve the immune level of children. It is worth popularizing and applying.