糖皮质激素联合综合康复疗法对Duchenne型肌营养不良患儿认知功能及炎性反应水平的影响

Effect of glucocorticoid combined with comprehensive rehabilitation therapy on cognitive function and inflammatory response level in children with Duchenne muscular dystrophy

目的观察糖皮质激素联合综合康复疗法对Duchenne型肌营养不良(DMD)患儿认知功能及炎性因子水平的影响。方法选取2017年5月—2019年5月新疆医科大学第一附属医院小儿内二科诊治Duchenne型肌营养不良患儿120例,随机数字表法分为对照组(60例)和观察组(60例)。对照组给予糖皮质激素治疗,观察组在上述治疗基础上加用综合康复疗法,疗程均为3个月。比较2组患儿临床疗效,治疗前后认知功能评分及血清CPK、LDH、AST炎性因子、免疫球蛋白水平变化。结果观察组治疗总有效率高于对照组(93.33%vs.70.00%,χ^(2)/P=10.909/0.001)。与治疗前比较,治疗后2组患者血清CK、LDH、AST、IL-1β、IL-6、TNF-α、IgM水平降低,FSIQ评分及血清IgA、IgG、IgE水平升高,且观察组各指标较对照组改善更为显著(t/P=10.095/<0.001,10.567/<0.001,5.386/<0.001,64.538/<0.001,50.993/<0.001,12.187/<0.001,9.937/<0.001,3.762/0.000,2.957/0.002,10.853/<0.001,7.395/<0.001)。结论糖皮质激素联合综合康复治疗DMD患儿,可以有效减轻机体炎性反应,增强免疫力,提高认知功能,改善病情,具有一定的临床应用价值。

Objective To observe the effect of glucocorticoid combined with comprehensive rehabilitation therapy on the cognitive function and the level of inflammatory factors in children with Duchenne muscular dystrophy(DMD).Methods From May 2017 to May 2019,120 children with Duchenne muscular dystrophy were diagnosed and treated in the Second Department of Pediatric Internal Medicine of the First Affiliated Hospital of Xinjiang Medical University.The random number table was divided into a control group(60 cases)and an observation group(60 cases).The control group was given glucocorticoid treatment,and the observation group was treated with comprehensive rehabilitation therapy on the basis of the above treatment.The course of treatment was 3 months.The clinical efficacy of the two groups of children were compared,the cognitive function score,serum,CPK,LDH,AST inflammatory factors,and immunoglobulin levels before and after treatment were compared.Results The total effective rate of treatment in the observation group was higher than that in the control group(93.33%vs.70.00%,χ^(2)/P=10.909/0.001).Compared with before treatment,after treatment,serum CK,LDH,AST,IL-1β,IL-6,TNF-α,IgM levels in the two groups decreased,and FSIQ score serum IgA,IgG,IgE levels increased,and the above indicators in the observation group were higher than those in the control group.The improvement is more significant(t/P=10.095/<0.001,10.567/<0.001,5.386/<0.001,64.538/<0.001,50.993/<0.001,12.187/<0.001,9.937/<0.001,3.762/0.000,2.957/0.002,10.853/<0.001,7.395/<0.001).Conclusion Glucocorticoids combined with comprehensive rehabilitation treatment of children with DMD can effectively reduce the body's inflammatory response,enhance immunity,enhance their cognitive function,and improve their condition.It has certain clinical application value.