静脉注射人免疫球蛋白治疗新生儿急性肺损伤/呼吸窘迫综合征的效果

Clinical efficacy of IVIG in treatment of neonatal acute lung injury or respiratory distress syndrome

目的探讨静注人免疫球蛋白(IVIG)在新生儿急性肺损伤/呼吸窘迫综合征(ALI/ARDS)临床治疗中的应用效果。方法选取2014年1月至2016年12月在东南大学附属盐城医院新生儿科住院的60例新生儿ALI/ARDS患者,按随机数字表法分为对照组和治疗组,每组30例。对照组予机械通气+肺表面活性物质、抗感染、营养等对症支持治疗,治疗组在对照组的基础上加用IVIG治疗。比较两组患儿治疗前、治疗后24、48及72小时血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、IL-10水平及机械通气时间、住院时间、病死率。结果治疗组患儿血清IL-6、TNF-α、血清IL-6、TNF-α较对照组降低(F时间/组间/交互=210.851/50.921/6.258,P时间/组间/交互<0.01,F时间/组间/交互=220.613/133.583/11.083,P时间/组间/交互<0.01),而IL-10较对照组升高(F时间/组间/交互=154.547/300.944/43.851,P时间/组间/交互<0.01),差异均有统计学意义(P均<0.05);治疗组机械通气时间、住院时间少于对照组,差异有统计学意义(P<0.05);治疗组病死率低于对照组,差异有统计学意义(P<0.05)。结论 IVIG治疗新生儿ALI/ARDS可以减轻全身炎症反应,缩短机械通气时间、住院时间,降低病死率,安全可靠。

Objective To explore the curative effect of intravenous immunoglobulin(IVIG)in treatment of those neonates with acute lung injury or acute respiratory distress syndrome(ALI/ARDS).Methods A total of 60 cases with neonatal ALI/ARDS hospitalized in our hospital from Jan 2014 to Dec 2016 were selected,and then divided into the treatment group and the control group by means of random number table,30 cases in each group.Besides such symptomatic supportive treatments as mechanical ventilation and pulmonary surfactants,anti-infection and nutrition support for the control group,neonates in the treatment group were given additional IVIG treatment.The serum levels of interleukin-6(IL-6),IL-10 and tumor necrosis factor-α(TNF-α)before and after treatment,together with ventilation time,hospitalization time and case fatality rate between the two groups were compared.Results Compared with the control group,the serum levels of IL-6 and TNF-αin the treatment group were much lower(F time/Between groups/interactive=210.851/50.921/6.258,P time/Between groups/interactive<0.01;F time/Between groups/interactive=220.613/133.583/11.083,P time/Between groups/interactive<0.01),and the IL-10 level after treatment in the treatment group was much higher and differences between the two groups were significant(F time/Between groups/interactive=154.547/300.944/43.851,P time/Between groups/interactive<0.01).The mechanical ventilation time and hospitalization time in the treatment group were significantly less than those in the control group(P<0.05).The case fatality rate in the treatment group was also significantly lower than that in the control group(P<0.05).Conclusion For those neonates with ALI/ARDS,application of IVIG treatment could reduce their systemic inflammatory responses,shorten the ventilation and hospitalization time,and further decrease the case fatality rate,with advantages of safety and reliability.