卡介苗接种预防毛细支气管炎婴儿日后发生喘息的探讨

Clinical study on the role of BCG alone or combination with vitamin A and IFN-γ in the prevention from wheezing episodes after infantile acute bronchiolitis

为观察卡介苗 (BCG)单用或联用干扰素γ(IFN_γ)和维生素A(VitA)对毛细支气管炎 (毛支 )患儿结核菌素纯蛋白衍化物 (PPD)皮肤试验、喘息发作及单核细胞源性细胞因子白细胞介素18(IL_18)水平的变化。给予44例毛支患儿单独BCG或合并IFN_γ/VitA治疗 ,于治疗前和3个月后进行PPD皮试 ,测定外周血单个核细胞体外产生IL_18的水平。随访时间平均1年 ,观察喘息发作情况。未接受BCG接种的19例毛支婴儿作为对照组。结果BCG接种后PPD平均硬结直径大于干预前及毛支对照组恢复期 ,以合并IFN_γ、VitA治疗组更为突出。BCG接种组1年内喘息发作频率低于对照组恢复期。干预后IL_18水平明显升高 ,尤以合并IFN_γ、VitA治疗组为高 ;PPD皮试强度与IL_18水平呈正相关。提示BCG可促进毛支患儿PPD皮试阳转率 ,增强IL_18活性 ,具有预防毛支患儿日后发展为哮喘的作用。IFN_γ。

To study the effects of BCG inoculation alone or combined with vitamin A and IFN-γ on the tuberculosis bacilli protein purified derivative(PPD)skin test,wheezing episode and dynamic changes in the level of interleuking 18(IL-18) derived from monocyte in infants with acute bronchiolitis,44 infants with acute bronchiolitis(ABI)were treated with BCG alone or combination with vitamin A and IFN-γ. While 19 infants with ABI only treated with conventional the-rapy worked as control group.PPD skin test and the IL-18 level derived from PBMC in vitro measured with ELISA were monitored before and 3 months after BCG inoculation,following-up for average 12 months to observe the frequency of the wheezing episodes.The mean indurations diameter of the PPD skin test in infants with ABI after BCG inoculation was larger than that of before inoculation and without BCG inoculation.The more strong PPD reaction was observed in infants treated with BCG inoculation and IFN-γ/vitamin A.The frequency of wheezing episodes in the BCG inoculation group was significantly lower than that in the control group in one year.With intervention,the IL-18 level was significantly higher,especially in the BCG inoculation combined with IFN-γ/vitamin A group.The intensity of PPD skin test had a positive correlation with the IL-18 level.BCG inoculation can enhance the positive diversion rate of the PDD skin test and IL-18 activity playing the active role in preventing the infants with ABI to develop asthma later on while vitamin A/IFN-γ has synergism with BCG.