重组人粒细胞集落刺激因子对早产儿早发型败血症合并中性粒细胞减少症的辅助治疗效果

Effect of RhG-CSF adjunctive therapy on neonatal sepsis complicated by neutropenia

目的研究重组人粒细胞集落刺激因子(rhG-CSF)对早产儿早发型败血症(NEOS)合并粒细胞减少症的辅助治疗效果。方法选取新生儿早发型败血症合并中性粒细胞减少症的早产儿为研究对象,随机分为对照组和治疗组。对照组给予抗菌药物及其他支持治疗,治疗组在对照组治疗的基础上加用rhG-CSF,5μg·kg^(-1)·d^(-1),皮下注射。观察治疗后2组患儿抗菌药物使用疗程、发生黄疸持续、粒细胞恢复、实验室检查、并发症以及不良反应等指标。结果 rhG-CSF辅助治疗可提高抗感染疗效,肌张力改变、血压降低、体温异常及黄疸持续与对照组比较差异有统计学意义(P<0.05);炎性指标降钙素原和C-反应蛋白水平与对照组比较差异有统计学意义(P<0.05);感染相关治疗,如住院、抗菌药物使用疗程、呼吸机的使用时间、治疗7 d危重症评分与对照组比较差异有统计学意义(P<0.05)。治疗组在治疗3和7 d后白细胞计数和中性粒细胞计数均显著升高(P<0.05)。结论 rhG-CSF辅助治疗NEOS合并中性粒细胞减少症可有效提高抗感染疗效,降低并发症发生率,明显提高白细胞与中性粒细胞计数水平,且无明显不良反应发生。

Objective To study the effect of adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG- CSF) on the outcome of neonatal early-onset septicemia (NEOS). Methods The neonates who met the early-onset sepsis clinical diagnostic criteria and associated with neutropenia syndrome were selected and randomly divided into control group and treatment group.The control group was treated with anti-infection and supportive treatment and the rhG-CSF treatment group was received extra rhG-CSF,5 μg·kg^-1 ·d^-1 . After treatment,the course of antibiotics,continuous time of jaundice,duration of ventilator days ,neutrophil recovery time,laboratory tests,incidence of side effects,white blood cell count and the absolute neutrophil count were observed and the treatment effect of the adjuvant treatment was evaluated. Results The rhG-CSF adjunctive therapy may improve the efficacy of anti-infection:there were significant differences in the four aspects of muscle tone change,lower blood pressure,abnormal body temperature and duration of jaundice between the rhG-CSF group and the control group ( P <0.05);The procalcitonin (PCT) and C- reactive protein (CRP) level between the rhG-CSF group and the control group had significant differences( P <0.05).The rhG-CSF treatment group showed a significant increase in white blood cell count and neutrophil count after 3 and 7 d treatment when compared with the control group ( P <0.05). Conclusion The rhG-CSF adjunctive treatment can improve the anti-infection effect,reduce the incidence of complications and significantly improve the level of leukocyte and neutrophil count,and no significant side effect was observed.