丙种球蛋白在先天性心脏病合并重症肺炎患儿中的应用

Administration of gamma globulin in children patients with congenital heart disease complicated by severe pneumonia

目的观察丙种球蛋白治疗先天性心脏病合并重症肺炎患儿的疗效及对炎症、免疫功能的影响。方法83例患儿随机分为对照组41例和观察组42例,对照组予以常规治疗,观察组加用丙种球蛋白静滴,5 d为一疗程。比较两组临床指标、炎症指标[超敏C反应蛋白(hs-CRP)、降钙素(PCT)、白介素-6(IL-6)、白介素-8(IL-8)和可溶性细胞间黏附分子-1(sICAM-1)]和免疫指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD3-CD16^(+)CD56^(+)、CD3^(+)CD16^(+)CD56^(+),IgA、IgG、IgM),记录不良反应。结果治疗后,与对照组相比,观察组呼吸困难消失时间、肺部啰音消失时间、体温恢复正常时间、白细胞恢复正常时间、胸片恢复正常时间及住院时间明显缩短(P<0.05);炎症指标hs-CRP、PCT、IL-6、IL-8和sICAM-1含量均显著下降(P<0.05);CD4^(+)、CD3-CD16^(+)CD56^(+)、CD3^(+)CD16^(+)CD56^(+)细胞亚群比例,CD4^(+)/CD8^(+)比值及IgA、IgG含量较高(P<0.05)。两组不良反应发生率相近。结论丙种球蛋白可降低先天性心脏病合并重症肺炎患儿炎症反应,提高免疫功能,值得临床推广。

Objective To observe the curative effect of gamma globulin in children patients with congenital heart disease(CHD)complicated by severe pneumonia and its influence on inflammation and immune function.Methods The children patients(n=83)were divided randomly into control group(n=41)and observation group(n=42).The control group was given routine treatment and observation group was additionally given intravenous drip of gamma globulin with 5 d as a therapeutic course.The clinical indexes,inflammatory indexes[high sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),interleukin-6(IL-6),interleukin-8(IL-8),soluble intercellular adhesion molecule-1(sICAM-1)]and immune indexes(CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CD3-CD16^(+)CD56^(+),CD3^(+)CD16^(+)CD56^(+),IgA,IgG,IgM)were compared between 2 group,and adverse reactions were recorded.Results After treatment,disappearance time of dyspnea and pulmonary rales,durations of returning to normal of body temperature,white cell count and X chest radiograph,and length of hospital stay were significantly shorter in observation group than those in control group(P<0.05).The levels of hs-CRP,PCT,IL-6,IL-8 and sICAM-1 decreased significantly in observation group(P<0.05).The proportions of cell subsets of CD4^(+),CD3-CD16^(+)CD56^(+)and CD3^(+)CD16^(+)CD56^(+),ratio of CD4^(+)/CD8^(+)and levels of IgA and IgG were higher in observation group than those in control group(P<0.05).The incidence rates of adverse reactions were similar in 2 groups.Conclusion Gamma globulin can relieve inflammatory reactions and improve immune function in children patients with CHD complicated by severe pneumonia,which is worthy of clinic application.