丙种球蛋白联合抗感染佐治小儿重症腺病毒肺炎的临床疗效
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摘要
目的探讨丙种球蛋白联合常规抗感染治疗重症腺病毒肺炎患儿的疗效。方法将菏泽市中医医院2018年1—12月收治的98例重症腺病毒肺炎患儿按照随机数字表法分为对照组(49例)和研究组(49例),对照组给予常规抗感染治疗,研究组加以丙种球蛋白辅助治疗。比较两组患儿临床疗效、机械通气时间、发热时间、住院时间、IgG、IgA、IgM、CD4+、CD8+、CD4+/CD8+水平以及不良反应发生率、病死率。结果研究组临床有效率(91.84%)显著高于对照组(77.55%),差异有统计学意义(P<0.05)。研究组机械通气时间、发热时间、住院时间均优于对照组;两组干预前IgG、IgA、IgM、CD4~+、CD8~+、CD4~+/CD8+比较差异均无统计学意义(均P>0.05),干预后研究组IgG、IgA、IgM、CD4~+、CD8~+、CD4~+/CD8~+均显著高于对照组,差异有统计学意义(均P<0.05)。研究组不良反应发生率及病死率与对照组比较,差异均无统计学意义(均P>0.05)。结论小儿重症腺病毒肺炎采用丙种球蛋白联合常规抗感染治疗可提高机体免疫功能,改善患者症状,且不良反应发生率及病死率较低。
Objective To explore the efficacy of gamma globulin combined with routine anti-infection therapy in children with severe adenovirus pneumonia. Methods Ninety-eight children with severe adenovirus pneumonia admitted to the Heze Hospital of Traditional Chinese Medicine from January to December 2018 were divided into control group(49 cases) and study group(49 cases)according to random number table method. The control group was given routine anti-infection treatment, and the study group was given the above treatment and adjuvant treatment of gamma globulin. The clinical efficacy, mechanical ventilation time, fever time,hospitalization time, levels of IgG, IgA, IgM, CD4~+, CD8~+ and CD4~+/CD8~+, incidence of adverse reactions and mortality were compared between the 2 groups. Results The clinical effective rate of the study group(91.84%) was significantly higher than that of the control group(77.55%), with statistically significant difference(P<0.05). The mechanical ventilation time, fever time and hospitalization time of the study group were better than those of the control group. There was no significant difference in the IgG,IgA, IgM, CD4+, CD8+ and CD4+/CD8+ between the 2 groups before the intervention(P>0.05). After the intervention, the IgG, IgA,IgM, CD4+, CD8+ and CD4+/CD8+ of the study group were significantly higher than those of the control group, with statistically significant difference(P<0.05). There was no significant difference in the incidence of adverse reactions and mortality between the study group and the control group(P>0.05). Conclusion Gamma globulin plus routine anti-infection therapy can improve the immune function and symptoms of children with severe adenovirus pneumonia, with low incidence of adverse reactions and mortality.
Objective To explore the efficacy of gamma globulin combined with routine anti-infection therapy in children with severe adenovirus pneumonia. Methods Ninety-eight children with severe adenovirus pneumonia admitted to the Heze Hospital of Traditional Chinese Medicine from January to December 2018 were divided into control group(49 cases) and study group(49 cases)according to random number table method. The control group was given routine anti-infection treatment, and the study group was given the above treatment and adjuvant treatment of gamma globulin. The clinical efficacy, mechanical ventilation time, fever time,hospitalization time, levels of IgG, IgA, IgM, CD4~+, CD8~+ and CD4~+/CD8~+, incidence of adverse reactions and mortality were compared between the 2 groups. Results The clinical effective rate of the study group(91.84%) was significantly higher than that of the control group(77.55%), with statistically significant difference(P<0.05). The mechanical ventilation time, fever time and hospitalization time of the study group were better than those of the control group. There was no significant difference in the IgG,IgA, IgM, CD4+, CD8+ and CD4+/CD8+ between the 2 groups before the intervention(P>0.05). After the intervention, the IgG, IgA,IgM, CD4+, CD8+ and CD4+/CD8+ of the study group were significantly higher than those of the control group, with statistically significant difference(P<0.05). There was no significant difference in the incidence of adverse reactions and mortality between the study group and the control group(P>0.05). Conclusion Gamma globulin plus routine anti-infection therapy can improve the immune function and symptoms of children with severe adenovirus pneumonia, with low incidence of adverse reactions and mortality.
引文
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[11]邓俊超,朱小石.儿童重症腺病毒肺炎临床特征及丙种球蛋白辅助治疗效果分析[J].临床误诊误治,2018,31(5):86-89.
[12]卢素琴,汪祝萍,洪燕.人免疫丙种球蛋白辅助治疗小儿重症肺炎的临床疗效及安全性[J].中国地方病防治杂志,2017,32(2):207-208.
[13]尹绪凤,雷勋明.丙种球蛋白对新生儿肺炎血清相关免疫指标的影响[J].中国医师进修杂志,2017,40(3):196-199.
[14]Shen CF,Wang SM,Ho TS,et al.Clinical features of community acquired adenovirus pneumonia during the 2011 community outbreak in Southern Taiwan:role of host immune response[J].BMC Infect Dis,2017,17(1):196.
[2]黄淼,罗蓉,符州.儿童重症腺病毒肺炎不良预后的危险因素分析[J].中国当代儿科杂志,2017,19(2):159-162.
[3]胡亚美,江载芳.诸福棠实用儿科学[M].7版.北京:人民卫生出版社,2003:1191-1195.
[4]British Thoracic Society Standards of Care Committee.British Thoracic Society Guidelines for the Management of Community Acquired Pneumonia in Childhood[J].Thorax,2002,57 Suppl1:i1-24.
[5]方鹏,杨金艳.儿童重症腺病毒肺炎预后不良的临床分析[J].罕少疾病杂志,2018,25(1):24-26.
[6]陈韦,卓安山,曹玉书,等.成人重症腺病毒肺炎临床研究[J].转化医学杂志,2018,7(3):171-174.
[7]Saettini F,Notarangelo LD,Biondi A,et al.Neutropenia,hypogammaglobulinemia,and pneumonia:A case of WHIMsyndrome[J].Pediatr Int,2018,60(3):318-319.
[8]应旦红,郑丽丽,许航燕.T细胞免疫及细胞因子与重症腺病毒肺炎的相关研究进展[J].浙江医学,2017,39(23):2183-2185,2189.
[9]邱瑜,张新萍.重症腺病毒肺炎患儿20例临床分析[J].中国医师杂志,2018,20(4):610-611.
[10]Jonnalagadda S,Rodríguez O,Estrella B,et al.Etiology of severe pneumonia in Ecuadorian children[J].PLoS One,2017,12(2):e0171687.
[11]邓俊超,朱小石.儿童重症腺病毒肺炎临床特征及丙种球蛋白辅助治疗效果分析[J].临床误诊误治,2018,31(5):86-89.
[12]卢素琴,汪祝萍,洪燕.人免疫丙种球蛋白辅助治疗小儿重症肺炎的临床疗效及安全性[J].中国地方病防治杂志,2017,32(2):207-208.
[13]尹绪凤,雷勋明.丙种球蛋白对新生儿肺炎血清相关免疫指标的影响[J].中国医师进修杂志,2017,40(3):196-199.
[14]Shen CF,Wang SM,Ho TS,et al.Clinical features of community acquired adenovirus pneumonia during the 2011 community outbreak in Southern Taiwan:role of host immune response[J].BMC Infect Dis,2017,17(1):196.