rhIFN-α1b与更昔洛韦治疗儿童传染性单核细胞增多症的效果及对患儿细胞、体液免疫功能的影响

Curative Effect of rhIFN-α1b and Ganciclovir on Children with Infectious Mononucleosis and Their Influences on Cellular and Humoral Immunity

目的探讨重组人干扰素α1b(rhIFN-α1b)与更昔洛韦治疗儿童传染性单核细胞增多症(IM)的疗效及对患儿细胞、体液免疫功能的影响。方法选取2021年3月至2023年3月在太康县人民医院确诊的100例IM患儿,采用简单随机分组将患儿分为rhIFN-α1b组和更昔洛韦组,每组各50例。更昔洛韦组患儿给予5 mg/kg更昔洛韦静滴治疗,3次/d,每次间隔8 h静滴治疗;rhIFN-α1b组给予2μg/kg的rhIFN-α1b雾化吸入治疗,2次/d,两组均持续治疗7 d。比较rhIFN-α1b组与更昔洛韦组的临床症状改善情况、外周血细胞免疫功能指标(CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞、CD4^(+)/CD8^(+)T淋巴细胞)、体液免疫功能指标[免疫球蛋白A(IgA)、免疫球蛋白G(IgG)]、血清炎症因子水平[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)];记录rhIFN-α1b组与更昔洛韦组治疗期间的不良反应发生情况。结果rhIFN-α1b组患儿退热、肝脾回缩、淋巴结缩小、肌酶恢复至正常时间均短于更昔洛韦组,差异具有统计学意义(P<0.05)。治疗7 d后,两组患儿外周血CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)T淋巴细胞均高于治疗前,CD8^(+)T淋巴细胞低于治疗前,且治疗7 d后rhIFN-α1b组CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)T淋巴细胞均高于更昔洛韦组,CD8^(+)T淋巴细胞低于更昔洛韦组,差异具有统计学意义(P<0.05)。治疗7 d后,两组患儿血清IgA、IgG水平高于治疗前,且治疗7 d后rhIFN-α1b组的IgA、IgG水平高于更昔洛韦组,差异具有统计学意义(P<0.05);治疗7 d后两组患儿IL-6、TNF-α水平低于治疗前,且治疗7 d后rhIFN-α1b组的IL-6、TNF-α水平低于更昔洛韦组,差异具有统计学意义(P<0.05)。两组患儿不良反应发生率比较,差异无统计学意义(P>0.05)。结论rhIFN-α1b治疗IM效果优于更昔洛韦,能调节患儿的细胞、体液免疫功能,且不会增加不良反应。

Objective To investigate the efficacy of recombinant human interferonα1b(rhIFN-α1b)and ganciclovir in the treatment of infectious mononucleosis(IM)in children,and the effects on the cellular and humoral immune functions of the children.Methods A total of 100 children with IM diagnosed at Taikang County People's Hospital between March 2021 and March 2023 were selected for inclusion in the study.These children were randomly assigned to either the rhIFN-α1b group or the ganciclovir group,with 50 cases in each group.The children in the ganciclovir group were administered 5 mg/kg ganciclovir three times a day at 8-hour intervals,while the children in the rhIFN-α1b group received 2μg/kg rhIFN-α1b nebulized inhalation treatment twice a day.Both groups were treated continuously for seven days.The treatment was continued for seven days.The clinical symptomatic improvement and peripheral blood cellular immune function indexes were compared between the rhIFN-α1b group and the ganciclovir group(CD3^(+)T-lymphocytes,CD4^(+)T-lymphocytes,CD8^(+)T-lymphocytes,CD4^(+)/CD8^(+)T-lymphocytes).Additionally,humoral immune function indexes[immunoglobulin A(IgA),immunoglobulin G(IgG)],and serum inflammatory factor levels[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α)]were recorded and compared between the rhIFN-α1b group and the ganciclovir group.The occurrence of adverse reactions during treatment was also recorded.Results The time required for children in the rhIFN-α1b group to return to normal following the regression from fever,liver and spleen retraction,lymph node shrinkage,and muscle enzymes was shorter than that observed in the ganciclovir group.This difference was statistically significant(P<0.05).After seven days of treatment,the peripheral blood CD3^(+)T lymphocytes,CD4^(+)T lymphocytes,and CD4^(+)/CD8^(+)T lymphocytes were higher than those before treatment,while the CD8^(+)T lymphocytes were lower than those before treatment in both groups.After seven days of treatment,the CD3^(+)T lymphocytes,CD4^(+)T lymphocytes,and CD4^(+)/CD8^(+)T lymphocytes were found to be higher than those of the ganciclovir group in the rhIFN-α1b group.The CD8^(+)T lymphocytes exhibited a statistically significant(P<0.05)reduction in comparison to the ganciclovir group.After seven days of treatment,the serum IgA and IgG levels of children in both groups were higher than those before treatment.Furthermore,the IgA and IgG levels of the rhIFN-α1b group were higher than those of the ganciclovir group after seven days of treatment,and the difference was statistically significant.The levels of IL-6 and TNF-αin children in both groups were found to be lower than those observed prior to treatment. Furthermore, the levels of IL-6 in the rhIFN-α1b group were found to be lower than those observed prior to treatment. The levels of TNF-α in the rhIFN-α1b group were lower than those in the ganciclovir group after seven days of treatment, and the difference was statistically significant (P < 0.05). A comparison of the incidence of adverse reactions between the two groups of children revealed no statistically significant difference (P > 0.05). Conclusion In the treatment of IM, rhIFN- α1b has been demonstrated to be more effective than ganciclovir. Additionally, it has been observed to modulate cellular and humoral immune function in children, with no additional adverse effects.