静脉注射丙种球蛋白在新生儿疾病中的应用

Application of intravenous gamma globulin in neonatal diseases

新生儿是人类迈向独立生存的初始阶段,需面对各种各样的挑战和难关,如感染关,但作为主力军的免疫系统发育不完善,防御薄弱、抵抗力不足,易罹患感染性疾病如新生儿感染性肺炎、新生儿败血症、新生儿化脓性脑膜炎、新生儿病毒性脑炎、新生儿肠道病毒性心肌炎等,这些疾病的发生发展影响着新生儿的生存质量,严重者会影响患儿预后,增加家庭负担;同时,新生儿体内从母体血液中获得的还未代谢完成的自身免疫性抗体会造成新生儿的免疫损伤如新生儿溶血病、新生儿红斑狼疮、新生儿血色素沉着症、新生儿同种免疫性血小板减少症、新生儿同种免疫性中性粒细胞减少症、暂时性新生儿重症肌无力等,母源性免疫性疾病部分会随着抗体的代谢完全而缓解,但过渡阶段仍会提升新生儿死亡率。另外,还有一类与免疫功能紊乱相关的疾病如川崎病、新生儿缺氧缺血性脑病、新生儿自身免疫性水疱病、巨噬细胞活化综合征、吉兰-巴雷综合征、僵人综合征等,虽新生儿群体不是其好发人群,但也会偶现其中一种或几种疾病,影响患儿生命。这三大类疾病均可通过静脉注射丙种球蛋白的辅助治疗获得有益的效果。此外,静脉注射丙种球蛋白制剂具有某些病原体的抗体活性,对免疫接种具有一定影响。故本文就丙种球蛋白在新生儿疾病中应用的潜在机制进行综述。

Compared with foetus,newborns have undergoing tremendous physiological changes.However,their immune system is weak and insufficient.Thus,newborns are susceptible to infectious diseases,such as neonatal infectious pneumonia,neonatal sepsis,neonatal purulent meningitis,neonatal viral encephalitis and neonatal enteroviral myocarditis.The occurrence and development of these diseases affect the quality of life and the prognosis of newborns,which increase the burden on the family.At the same time,the autoimmune antibodies,obtained from the mother’s blood but have not been metabolised,can cause immune damage to the newborn,such as neonatal haemolytic disease,neonatal lupus erythematosus,neonatal hemochromatosis,neonatal alloimmune thrombocytopaenia,neonatal alloimmune neutropaenia and temporary neonatal myasthenia gravis.Some of these diseases are relieved following the metabolism of antibodies but still increase neonatal mortality.In addition,some diseases are related to immune dysfunction,such as Kawasaki disease,hypoxic-ischemic encephalopathy,neonatal autoimmune blistering disease,macrophage activation syndrome,Guillain-Barrésyndrome and stiff-person syndrome.Although they are not common in the newborn population,one or more of these diseases will occasionally occur.Adjuvant therapy using intravenous gamma globulin can effectively treat these diseases.In addition,gamma globulins have similar ability to antibodies against certain antigens,so they have a certain impact on vaccination.This article reviews the potential mechanism of gamma globulins in neonatal diseases.