新生儿破伤风应用静脉丙种球蛋白的免疫效果

EFFECTS OF IVIG ON IMMUNE FUNCTION IN TETANUS NEONATORUM

探讨国产人血静脉丙种球蛋白(IVIG)辅助治疗新生儿破伤风的临床疗效及免疫功能。将40例新生儿破伤风患儿按病例编号分为常规组和IVIG组各20例。常规组采用破伤风抗毒素及安定类药物治疗;IVIG组在常规治疗组方案基础上加用IVIG(400mg/kg·d,静脉点滴,每日一次)共3天。并设20例健康新生儿作对照组。检测血清IgA、IgG、IgM和外周血T淋巴细胞亚群。比较实验前后的临床疗效和免疫功能变化。结果显示:①新生儿破伤风患儿血清IgG、CD_3、CD_4水平明显低于健康对照组;②静脉注射IVIG后,可迅速提高新生儿破伤风患儿血清IgG水平(5.86±0.62vs11.71±1.46)g/L,同时可提高CD_4细胞数(32.55±2.51vs44.23±4.87)和CD_4/CD_8比值(1.30±0.19 vs 2.10±0.11),P均<0.001;③IVIG组治愈率为85％,明显高于常规组55％,(x^2=4.28,P<0.05)。而平均治愈天数由(14.55±2.78)d缩短为(10.50±2.54)d(t=4.13,P<0.001)。病死率由20%降至10%。结论:免疫功能紊乱可能与新生儿破伤风有关。适宜的IVIG剂量辅助治疗新生儿破伤风,疗效肯定,副作用少,值得临床推广。

To investigate the clinical and immune efficiency of intravenous immunoglobulin( IVIG) manufacture domestically as a complementary way in treating tetanus neonatorum. Forty patients were enrolled into the study. Twenty patients were treated with Tetants antitoxin and Clonazepam(Routine group), while the other group(IVIG group) was treated with Tetants antitoxin , Clonazepam and IVIG(400 mg/kg d, iv, qd) for three days. The level of IgA,IgG,gM in serum and the peripheral T lymphocyte subsets were measured. Results showed: (1)The level of IgG,CD3,CD4 in tetanus neonatorum significantly depressed, compared with that control group.(2)Following the IVIG therapy, the level of IgG increased quickly from (5.86+0.62)g/Lto (11.71 + 1.46)g/L in 20 cases of IVIG group, CD4 from (32.55 + 2.51)% to (44.23 +4.87)% and CD4/CD8 from (1.30 +0.19) to (2.10 + 0.11), P all < 0.001;(3)The cure rate was 85% in IVIG group, which was significantly higher than that in Routine group(55%,x2= 4.28, P<0.05). The course of treatment was shortened from(14.55+2.78)d to (10.50+2.54)d (t = 4.13, P<0.001). The mortality was reduced from 20% to 10%. Conclution: Our study indicated that tetanus neonatorum may be related to disorder in immune funtion. Proper IVIG was safe and effective as complementary way in treating tetanus neonatorum and worth to be recommended.