血必净辅治抗N-甲基-D-天冬氨酸受体脑炎的效果及其对Th1/Th2免疫反应的影响

Study on the effect of Xuebijing on anti-NMDAR encephalitis and the changes of Th1/Th2 immune response

目的探究血必净辅治抗N-甲基-D-天冬氨酸受体(NMDAR)脑炎的效果及对辅助性T细胞1(Th1)/Th2免疫反应变化的影响。方法选取2021年1月—2023年12月海南医科大学第二附属医院神经内科收治的抗NMDAR脑炎患者120例,通过随机数字表法分为观察组60例和对照组60例。对照组采用血浆置换治疗,观察组在对照组基础上加用血必净治疗,疗程均为10 d。比较2组临床疗效、精神好转与症状改善时间、预后情况及不良反应总发生率,治疗前后T淋巴细胞亚群变化(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、Th1[干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)]与Th2[白介素-6(IL-6)、白介素-4(IL-4)]相关细胞因子水平。结果2组患者临床疗效比较差异无统计学意义(P>0.05);观察组精神好转、症状改善时间均短于对照组(t/P=3.935/<0.001,3.720/<0.001);治疗后观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组(t/P=3.017/0.003,5.062/<0.001,3.211/0.002);治疗后观察组IFN-γ、TNF-α、IL-6水平均低于对照组,IL-4高于对照组(t/P=4.911/<0.001,4.489/<0.001,3.289/0.001,4.191/<0.001);2组患者预后情况、不良反应总发生率比较差异无统计学意义(P>0.05)。结论血必净辅助治疗抗NMDAR脑炎患者可有效改善症状,调节免疫功能,这一作用可能与Th1/Th2平衡改善有关,且安全性较好。

Objective To investigate the effect of Xuebijing in treating N methyl D aspartate receptor(NMDAR)encephalitis and the changes of helper T cell 1(Th1)/Th2 immune response.Methods One hundred and twenty patients with anti-NMDAR encephalitis admitted to the Department of Neurology of the Second Affiliated Hospital of Hainan Medical University from January 2021 to December 2023 were selected and divided into observation group(60 cases)and control group(60 cases)by random number table method.The control group was treated with plasma exchange,and the observation group was treated with Xuebijing on the basis of the control group.The course of treatment was 10 days.The clinical efficacy,mental improvement and symptom improvement time,relevant cytokine levels,prognosis and overall incidence of adverse reactions,changes in T lymphocyte subsets(CD3^(+),CD4^(+),CD4^(+)/CD8^(+)),Th1[interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α)]and Th2[interleukin-6(IL-6),interleukin-4(IL-4)]before and after treatment were compared between the two groups.Results There was no significant difference in clinical efficacy between the two groups(P>0.05).The time of mental improvement and symptom improvement in the observation group was shorter than that in the control group(t/P=3.935/<0.001,3.720/<0.001).After treatment,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group(t/P=3.017/0.003,5.062/<0.001,3.211/0.002).After treatment,the levels of IFN-γ,TNF-αand IL-6 in the observation group were lower than those in the control group,and IL-4 was higher than that in the control group(t/P=4.911/<0.001,4.489/<0.001,3.289/0.001,4.191/<0.001).There was no statistically significant difference in prognosis and total incidence of adverse reactions between the two groups(P>0.05).Conclusion Xuebijing can effectively improve symptoms and regulate immune function in patients with anti-NMDAR encephalitis,which may be related to the improvement of Th1/Th2 balance,and the safety is good.