大剂量静注人免疫球蛋白联合纳洛酮治疗小儿重症病毒性脑炎疗效及对患儿神经功能、免疫功能的影响

Effect of high-dose gamma globulin combined with naloxone on neurological and immune function in children with severe viral encephalitis

目的探讨大剂量静注人免疫球蛋白联合纳洛酮治疗小儿重症病毒性脑炎疗效及对患儿神经功能、免疫功能的影响。方法选择2012年3月至2017年5月温岭市第一人民医院收治的小儿病毒性脑炎患儿103例,按照随机数字表法分为观察组53例、对照组50例,对照组给予常规治疗措施,观察组在常规治疗基础上使用纳洛酮联合大剂量静注人免疫球蛋白。比较两组患儿治疗疗效,临床症状改善情况,血清神经功能指标以及体液免疫功能改善情况。结果观察组患儿治疗总有效率显著高于对照组(92.45%比78.00%)(χ2=4.319,P<0.05)。观察组患儿发热消失时间、惊厥消失时间、意识障碍消失时间、脑膜刺激征消失时间、颅神经受累消失时间、脑电图恢复时间及住院时间均显著短于对照组[(2.17±0.56)d比(3.12±0.79)d,(2.25±0.31)d比(3.87±0.93)d,(3.84±0.46)d比(5.31±0.69)d,(2.01±0.83)d比(3.86±1.21)d,(1.85±0.58)d比(2.79±0.77)d,(11.36±2.14)d比(13.05±1.85)d,(10.21±3.05)d比(13.85±3.72)d](t=7.072、11.998、12.789、9.093、7.024、4.276、5.444;均P<0.05)。治疗后两组患儿血清NSE、S-100β及NGF水平均显著降低[(12.64±1.22)ng/L比(18.95±2.15)ng/L,(0.85±0.24)ng/L比(1.69±0.35)ng/L,(0.17±0.05)ng/mL比(0.98±0.12)ng/mL,(16.38±1.38)ng/L比(19.04±2.78)ng/L,(1.22±0.30)ng/L比(1.70±0.41)ng/L,(0.33±0.10)ng/mL比(0.96±0.14)ng/mL,t=18.583、14.010、45.361、6.239、6.878、25.58;均P<0.05],且观察组患儿血清神经功能指标显著低于对照组(t=14.592、6.931、10.358;均P<0.05)。治疗后两组患儿IgG显著升高[(15.62±2.31)g/L比(9.12±1.74)g/L,(11.52±2.05)g/L比(8.97±1.56)g/L](t=16.363、6.999;均P<0.05),且治疗后观察组患儿IgG水平显著高于对照组(P<0.05);治疗前后两组IgM水平差异均无统计学意义(P>0.05)。结论大剂量静注人免疫球蛋白联合纳洛酮可有效提高小儿重症病毒性脑炎临床疗效,有助于患儿临床症状、体征的改善,并可有效促进患儿神经功能的恢复以及免疫功能的提高,值得临床推广。

Objective To investigate the effect of high dose gamma globulin combined with naloxone in the treatment of severe viral encephalitis in children, and its influence on nerve function and immune function. Methods From March 2012 to May 2017, 103 children with viral encephalitis in the First People's Hospital of Wenling were randomly divided into observation group (53 cases) and control group (50 cases) according to the digital table.The control group was given routine treatment.The observation group was given naloxone combined with high dose gamma globulin on the basis of routine treatment.The therapeutic effect, clinical symptoms, serum neurological function and humoral immune function were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group (92.45% vs.78.00%)(χ2=4.319, P<0.05). The clinical symptoms, signs disappearance time and hospitalization time of the observation group were significantly shorter than those of the control group [(2.17±0.56)d vs.(3.12±0.79)d;(2.25±0.31)d vs.(3.87±0.93)d;(3.84±0.46)d vs.(5.31±0.69)d;(2.01±0.83)d vs.(3.86±1.21)d;(1.85±0.58)d vs.(2.79±0.77)d;(11.36±2.14)d vs.(13.05±1.85)d;(10.21±3.05)d vs.(13.85±3.72)d](t=7.072, 11.998, 12.789, 9.093, 7.024, 4.276, 5.444, all P<0.05). After treatment, the serum NSE, S-100β and NGF levels of the two groups were significantly decreased[(12.64±1.22)ng/L vs.(18.95±2.15)ng/L,(0.85±0.24)ng/L vs.(1.69±0.35)ng/L,(0.17±0.05)ng/mL vs.(0.98±0.12)ng/mL,(16.38±1.38)ng/L vs.(19.04±2.78)ng/L,(1.22±0.30)ng/L vs.(1.70±0.41)ng/L,(0.33±0.10)ng/mL vs.(0.96±0.14)ng/mL](t=18.583, 14.010, 45.361, 6.239, 6.878, 25.58, all P<0.05), and the serum neurological function indicators of the observation group were significantly lower than those of the control group (t=14.592, 6.931, 10.358, all P<0.05). After treatment, the level of IgG in the two groups were significantly higher than those before treatment[(15.62±2.31)g/L vs.(9.12±1.74)g/L;(11.52±2.05)g/L vs.(8.97±1.56)g/L](t=16.363, 6.999, all P<0.05), and the IgG level in the observation group was significantly higher than that in the control group(P<0.05). There were no significant changes in the levels of IgM in the two groups before and after treatment (all P>0.05). Conclusion High-dose gamma globulin combined with naloxone can effectively improve the clinical efficacy of severe viral encephalitis in children, help to improve the clinical symptoms and signs of children, at the same time help to restore the nervous function of children and improve the humoral immune function, which is worthy of clinical application.