静脉免疫球蛋白治疗急性脑梗死的临床研究

A study on clinical effects of intravenous immunoglobulin therapy for cerebral infarction

目的 探讨应用静脉免疫球蛋白 (IVIG)以调节和抑制急性脑梗死后的神经免疫异常 ,保护脑细胞、减轻脑梗死后引起的脑水肿、脑损伤。方法 4 0例患者按入院顺序应用双盲法随机分组 ,对照组 2 0例 ,治疗组 2 0例。对照组给予丹参、阿司匹林等常规治疗 15 d。治疗组应用 15 d常规治疗的同时 ,在确诊后第 2天给予连续 5 d的 IVIG 2 .5 g治疗 ,并对治疗组及对照组进行治疗前、治疗后不同时期的 Ig G、Ig A、Ig M、CD4 + TC、CD8+TC、血液流变学指标的动态观察。结果 1治疗组总有效率为 90 %、而对照组总有效率 6 0 % ,两组比较差异有显著性 ;2治疗组 CD4 + TC、CD8+ TC经治疗后升高 ;3治疗组 Ig G经治疗后降低 ;4治疗组和对照组经治疗后 ,血液黏滞状态有好转 ,但治疗组和对照组的血液流变学指标差异无显著性。结论 IVIG应用治疗急性脑梗死 ,能提高临床疗效 ,调节脑梗死后增高的 Ig G水平和降低的 CD4 + TC、CD8+ TC水平 ,而对血液流变学指标则无影响 。

Objective To investigate the therapeutic effects of intravenous immunoglobulin (IVIG) and dynamically check the serial concentrations of IgG,IgA,IgM,CD4 +TC,CD8 +TC,and hemodynamic properties in patients with acute cerebral infarction.Methods Forty cases with acute cardiovascular disease (ACVD) were randomly divided into two groups.Group 1 patients (n=20) were treated with IVIG 2.5 g for 5 days combined with routine treatment for 15 days (as treated group,TG).Group 2 patients (n=20) only received the routine treatment as control group for 15 days (CG).Meanwhile,blood IgG,IgA,IgM,CD4 +TC,CD8 +TC,and hemodynamic indices were detected before the treatment,and 2,5,15,28 days after the treatment.Results ①The total effective rates were 90% and 60% in TG and CG respectively (P<0.05). There was significant difference between the two groups.②After IVIG treatment TG had an increase in CD4 +TC,CD8 +TC,with a significant difference from CG.③After IVIG treatment TG had a decrease in IgG,with a significant difference from CG.④The two groups all got an improved conditon of blood viscosity and coagulation after treatment,but no significant difference existed between their hemodynamic indices.Conclusion Intravenous immunoglobulin used in treating acute cerebral infarction may improve the clinical curative effect,dually modulate the increased IgG level and decreased levels of CD4 +TC,CD8 +TC after cerebral infarction;but it gives no influence to the hemodynamic indices,not heightening the blood coagulation or viscosity.