重组人干扰素α-1b辅助治疗手足口病疗效分析
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摘要
目的探讨重组人干扰素α-1b压缩雾化吸入辅助治疗手足口病疗效及安全性。方法将207例手足口病患儿随机分为治疗组105例及对照组102例,对照组给以利巴韦林针10 mg/(kg·d)静点,治疗组在对照组治疗的基础上加用重组人干扰素α-1b压缩雾化吸入,20μg/次,2次/d,疗程5天。同时设立健康组30例,分别收集两组患儿急性期、恢复期及健康组患儿外周血标本各30份,应用ELISA法检测其血清中IFN-γ及IL-4的水平。结果治疗组总有效率87.92%,对照组总有效率76.47%,两组比较差异有统计学意义(P<0.05),且治疗组退热时间、皮疹消退时间均短于对照组,而两组合并脑炎的发生率无明显差异,治疗期间两组患儿均未出现药物不良反应。两组患儿急性期血清IFN-γ及IL-4水平均较健康组升高,差异有统计学意义(P<0.05);恢复期两组患儿血清IFN-γ及IL-4逐渐恢复至正常水平。结论重组人干扰素α-1b压缩雾化吸入辅助治疗普通型手足口病疗效确切,值得临床推广,但尚不能阻止疾病进展。
Objective To discuss the effect and safety of the adjuvanttherapy for hand-foot-mouth disease with human recombinant interferonalph-1 b.Methods Totally 207 cases of children with hand-foot-mouth disease were randomly divided into two groups. 105 HFMD children were allocated into the treatment group and 102 were allocated into the control group. The cases of control group were treated with ribavirin(10 mg/kg·d) an intravenous drip. The cases of treatment group were treated with human recombinant interferon alph-1 b(20 μg,bid,compression atom-izinginhalation).Results The total effective rate of treatment groupwas significantly higher than that of control group.The time of the defervescence and deflorescence were shorter than the control group and the incidence rate of encephalitis in the two groups has no diff-erence.During the treatment of two groups of children with no adversedrug reactions occurred. The serum concentrations of IFN-γand IL-4 in the two groups were significantly higher than that in the healthy group during the acute stage(P<0.05)and declined in comparing with the healthy group Along with the gradual recovery(P>0.05).Conclusion Interferon treatment of hand-foot-mouth disease in child-ren is safe and effective, and is worth clinically used,but can not prevent progression of HFMD.
Objective To discuss the effect and safety of the adjuvanttherapy for hand-foot-mouth disease with human recombinant interferonalph-1 b.Methods Totally 207 cases of children with hand-foot-mouth disease were randomly divided into two groups. 105 HFMD children were allocated into the treatment group and 102 were allocated into the control group. The cases of control group were treated with ribavirin(10 mg/kg·d) an intravenous drip. The cases of treatment group were treated with human recombinant interferon alph-1 b(20 μg,bid,compression atom-izinginhalation).Results The total effective rate of treatment groupwas significantly higher than that of control group.The time of the defervescence and deflorescence were shorter than the control group and the incidence rate of encephalitis in the two groups has no diff-erence.During the treatment of two groups of children with no adversedrug reactions occurred. The serum concentrations of IFN-γand IL-4 in the two groups were significantly higher than that in the healthy group during the acute stage(P<0.05)and declined in comparing with the healthy group Along with the gradual recovery(P>0.05).Conclusion Interferon treatment of hand-foot-mouth disease in child-ren is safe and effective, and is worth clinically used,but can not prevent progression of HFMD.
引文
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[13] 杜潘艳,赵军.肠道病毒EV71感染重症手足口病患儿血清干扰素-γ与白介素-10表达[J].中华医院感染学杂志,2012,22(19):4194-4196.
[14] 刘炜,周崇臣,包丰昌,等.手足口病患儿血液免疫学改变及其临床意义[J].河南医学研究,2011,20(4):406-410.
[15] Wang SM,Lei HY,Huang KJ,et al.Pathogenesis of enterovirus 71 brainstemencephalitis in pediatric patients:roles ofcytokines and cellμlar immune activation inpatients with pμlmonary edema[J].Infect.Dis.2003,188(4):564–570.
[16] 白敏,韩宜姚.EV71感染手足口病患儿Th细胞免疫变化及其意义[J].检验与临床,2012,50(32):77-80.
[2] 中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):1473-1475.
[3] 杨群燕,鲁月.干扰素、丙种球蛋白治疗手足口病合并病毒性脑炎的疗效及病情改善时间对比研究[J].中国生化药物杂志,2016,2(36):162-164.
[4] Shin-Min Wang,Huan-Yao Lei,Ching-Chuan Liu.Cytokine immunepath-genesis of enterovirus 71 brain stem encephalitis[J].Clinical and Developmental Immunology ,Volume 2012,Article ID 876241,8 pages.
[5] 林涛.丙种球蛋白及干扰素治疗手足口病合并病毒性脑炎临床疗效观察[J].中国全科医学,2013,16(3):323-325.
[6] 徐艳利,田庆玲,姜太一,等.雾化吸入重组人干扰素α1b对重症手足口病早期的治疗作用[J].中华实用儿科临床杂志,2015,30(8):627-630.
[7] 王蕻馨,张剑,李俊红.重组人干扰素α-1b雾化吸入治疗小儿重症手足口病的临床观察与护理[J].传染病信息,2014,27(3):176-177,192.
[8] Lee DS,Lee YI,Ahn JB,et al.Massive pulmonary hemorrhage in enterovirus 71-infected hand,foot,and mouth disease[J].Korean J Pediatr,2015,58 (3) :112-115.
[9] Li S,Cai C,Feng J,et al.Peripheral T lymphocyte subset imbalances in children with enterovirus 71-induced hand,foot and mouth disease[J].Virus Res,2014,180:84–91.
[10] Jiang T,Li SJ,Ouyang WX,et al.Changes in Th17 and CD4+CD25+Treg cells and their significance among children with hand,foot and mouth disease[J].Zhongguo Dang Dai Er Ke Za Zhi,2013,15(12):1113–1115.
[11] Wei R,Xu L,Zhang N,et al.Elevated antigen-specific Th2 type response is associated with the poor prognosis of hand,foot and mouth disease[J].Virus Res,2013,177(1):62–65.
[12] Andrea J Sant,Andrew Mc Michael.Revealing the role of CD+T cells in viral immunity[J].JEM,2012,209(8):1391-1395.
[13] 杜潘艳,赵军.肠道病毒EV71感染重症手足口病患儿血清干扰素-γ与白介素-10表达[J].中华医院感染学杂志,2012,22(19):4194-4196.
[14] 刘炜,周崇臣,包丰昌,等.手足口病患儿血液免疫学改变及其临床意义[J].河南医学研究,2011,20(4):406-410.
[15] Wang SM,Lei HY,Huang KJ,et al.Pathogenesis of enterovirus 71 brainstemencephalitis in pediatric patients:roles ofcytokines and cellμlar immune activation inpatients with pμlmonary edema[J].Infect.Dis.2003,188(4):564–570.
[16] 白敏,韩宜姚.EV71感染手足口病患儿Th细胞免疫变化及其意义[J].检验与临床,2012,50(32):77-80.