乙酰谷酰胺联合阿昔洛韦治疗小儿病毒性脑炎疗效观察

Efficacy of aceglutamide combined with acyclovir on viral encephalitis in children

目的观察小儿病毒性脑炎应用乙酰谷酰胺联合阿昔洛韦治疗的效果和安全性,探讨其可能机制。方法病毒性脑炎患儿112例,随机分为观察组和对照组各56例。对照组给予阿昔洛韦250mg/m2,静脉滴注,1次/12h;观察组在对照组治疗基础上给予乙酰谷酰胺2mg/kg,静脉滴注,1次/d;2组疗程均为7d。2组分别于治疗前及治疗7d后采用ELISA法测定血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、S-100β、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-6(interleukin-6,IL-6)水平;记录2组症状改善时间;治疗7d后评定比较2组治疗效果。结果观察组治疗前NSE[(35.32±5.16)μg/L]、S-100β[(21.31±1.81)μg/L]、TNF-α[(67.04±13.18)μg/L]、IL-6[(43.52±7.16)μg/L]水平与对照组[(35.27±5.13)、(21.27±1.82)、(66.32±13.14)、(43.36±7.14)μg/L]比较差异均无统计学意义(P>0.05);治疗7d后观察组、对照组NSE[(11.33±1.54)、(18.72±2.16)μg/L]、S-100β[(8.14±0.72)、(13.36±1.15)μg/L]、TNF-α[(18.62±3.62)、(32.45±7.13)μg/L]、IL-6[(14.63±2.26)、(21.55±4.11)μg/L]均较治疗前下降(P<0.05),观察组低于对照组(P<0.05)。观察组呕吐消失时间[(3.23±0.57)d]、体温正常时间[(3.06±0.52)d]、头痛消失时间[(3.63±0.62)d]、惊厥消失时间[(2.24±0.36)d]、意识清醒时间[(4.07±0.65)d]短于对照组[(5.46±1.02)、(4.32±0.73)、(5.38±1.12)、(4.13±0.48)、(5.84±0.83)d](P<0.05)。观察组总有效率(94.6%)高于对照组(80.4%)(P<0.05)。结论小儿病毒性脑炎应用乙酰谷酰胺联合阿昔洛韦治疗可明显减轻炎性反应,改善症状,减轻神经损伤。

Objective To investigate the efficacy and safety of aceglutamide combined with acyclovir in the treatment of viral encephalitis in children and to analyze its potential mechanism.Methods Totally 112children with viral encephalitis were randomly and equally divided into observation group and control group.Control group was given intravenous injection of 250mg/m2 acyclovir once per 12hfor 7days,in addition to which,observation group was given intravenous injection of 2mg/kg aceglutamide once per 24hfor 7days.The expressions of neuron specific enolase(NSE),S-100β,tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)were measured by ELISA before and after 7-day treatment.The time of the symptoms beginning to alleviate was recorded,and the efficacy was evaluated after 7-day treatment between two groups.Results The expressions of NSE((35.32±5.16)μg/L vs.(35.27±5.13)μg/L),S-100β((21.31±1.81)μg/L vs.(21.27±1.82)μg/L),TNF-α((67.04±13.18)μg/L vs.(66.32±13.14)μg/L)and IL-6((43.52±7.16)μg/L vs.(43.36±7.14)μg/L)showed no significant differences between observation group and control group before treatment(P>0.05),which were higher than those after 7-day treatment(NSE:(11.33±1.54),(18.72±2.16)μg/L;S-100β:(8.14±0.72),(13.36±1.15)μg/L;TNF-α:(18.62±3.62),(32.45±7.13)μg/L;IL-6:(14.63±2.26),(21.55±4.11)μg/L)(P<0.05),and lower in observation group than those in control group(P<0.05).The time periods of vomiting disappearing,temperature returning normal,headache disappearing,convulsion disappearing and consciousness recovery were significantly shorter in observation group((3.23±0.57),(3.06±0.52),(3.63±0.62),(2.24±0.36),(4.07±0.65)d)than those in control group((5.46±1.02),(4.32±0.73),(5.38±1.12),(4.13±0.48),(5.84±0.83)d)(P<0.05).The total effective rate was higher in observation group(94.6%)than that in control group(80.4%)(P<0.05).Conclusion Aceglutamide combined with acyclovir can significantly reduce the inflammatory response,relieve symptoms,and reduce nerve injury in children with viral encephalitis.