重组人干扰素α1b联合更昔洛韦对传染性单核细胞增多症合并肝功能异常患儿炎症免疫和肝功能的影响

Effects of Recombinant Human Interferonα1b Combined with Ganciclovir on Inflammatory Immunity and Liver Function in Children with Infectious Mononucleosis Complicated with Hepatic Dysfunction

目的:探讨重组人干扰素α1b联合更昔洛韦治疗传染性单核细胞增多症(IM)合并肝功能异常患儿的疗效和安全性。方法:将2020年1月至2021年6月南通大学附属海安医院收治的130例IM合并肝功能异常患儿分为观察组和对照组。对照组65例患儿静脉滴注更昔洛韦治疗,观察组65例患儿在此基础上加用重组人干扰素α1b雾化吸入治疗。观察两组患儿治疗前和治疗10 d后的免疫指标、炎症指标[血清淀粉样蛋白A(SAA)、肿瘤坏死因子α(TNF-α)和白细胞介素1β(IL-1β)]和肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和γ-谷氨酰转肽酶(GGT)]的变化,以及临床疗效和安全性。结果:治疗后,观察组患儿的CD3^(+)水平低于对照组,CD4^(+)、CD19^(+)水平高于对照组,差异均有统计学意义(t分别为9.365、7.492和8.127,P<0.05)。治疗后,观察组患儿的SAA、TNF-α和IL-1β水平低于对照组,差异均有统计学意义(t分别为12.982、8.651和17.849,P<0.05)。治疗后,观察组患儿的ALT、AST和GGT水平低于对照组,差异均有统计学意义(t分别为7.492、8.427、8.654,P<0.05)。观察组患儿三联征消失、肝脾肿大消退和异型淋巴细胞恢复的时间短于对照组,差异均有统计学意义(t分别为9.536、8.567和7.859,P<0.05)。观察组患儿EB病毒DNA转阴率为92.31%(60/65),高于对照组的81.54%(53/65),差异有统计学意义(χ^(2)=3.762,P<0.05)。两组患儿不良反应发生率的差异无统计学意义(P>0.05)。结论:重组人干扰素α1b联合更昔洛韦能显著改善IM合并肝功能异常患儿T淋巴细胞的免疫功能,减轻机体的炎症反应,改善肝功能,促进临床症状恢复,安全性较高。

OBJECTIVE:To probe into the efficacy and safety of recombinant human interferonα1b combined with ganciclovir in the treatment of infectious mononucleosis(IM)complicated with hepatic dysfunction.METHODS:A total of 130 children with IM complicated with hepatic dysfunction in Hai’an Hospital Affiliated to Nantong University from Jan.2020 to Jun.2021 were divided into observation group and control group.The 65 children in control group was given ganciclovir for intravenous drip,while the 65 children in observation group was given recombinant human interferonα1b for aerosol inhalation based on the control group.Changes in indicators of immunity,inflammation[serum amyloid protein A(SAA),tumor necrosis factorα(TNF-α)and interleukin 1β(IL-1β)]and liver function[alanine aminotransferase(ALT),aspartate transaminase(AST)andγ-glutamyl transpeptidase(GGT)],clinical efficacy and security indicators in the two groups were observed before treatment and 10d after treatment.RESULTS:After treatment,the CD3^(+)level of the observation group was lower than that of the control group,the CD4^(+)and CD19^(+)levels of the observation group were higher than those of the control group,with statistically significant differences(t was 9.365,7.492 and 8.127,respectively,P<0.05).After treatment,the SAA,TNF-αand IL-1βlevels of the observation group were lower than those of the control group,with statistically significant differences(t was 12.982,8.651 and 17.849,respectively,P<0.05).After treatment,the ALT,AST and GGT levels of the observation group were lower than those of the control group,with statistically significant differences(t was 7.492,8.427 and 8.654,respectively,P<0.05).The disappearance time of triad signs,regression time of hepatosplenomegaly and recovery time of heterogeneous lymphocytes of the observation group were shorter than those of the control group,with statistically significant difference(t was 9.536,8.567 and 7.859,respectively,P<0.05).The DNA conversion rate of EB virus of the observation group was 92.31%(60/65),which was higher than that of the control group(81.54%,53/65),with statistically significant difference(χ^(2)=3.762,P<0.05).The difference in the incidence of adverse drug reactions between the two groups was not statistically significant(P>0.05).CONCLUSIONS:Recombinant human interferonα1b combined with ganciclovir can significantly improve immune function of T lymphocytes in children with IM combined with hepatic dysfunction,reduce inflammatory response of the organism,improve liver function and promote the recovery of clinical symptoms,with high safety.