重组人干扰素α-1b联合大剂量丙种球蛋白治疗重症手足口病合并病毒性脑炎的疗效
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摘要
目的探究重组人干扰素α-1b联合大剂量丙种球蛋白治疗重症手足口病(HFMD)合并病毒性脑炎的临床效果。方法选取2014年2月至2017年4月宜宾市第二人民医院收治135例HFMD并病毒性脑炎患儿,按随机数字表法分为对照A组(重组人干扰素α-1b)、对照B组(大剂量丙种球蛋白)及观察组(重组人干扰素α-1b+大剂量丙种球蛋白),各45例。比较三组患儿疗效、治疗后血清胰岛素样生长因子-1(IGF-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、S100B、神经特异性烯醇化酶(NSE)水平及血清T细胞亚群水平变化情况。结果观察组总有效率(93. 33%)高于对照A组、B组(73. 33%、73. 56%),差异有统计学意义(P <0. 05)。治疗后,观察组CD3~+、CD4~+、CD4~+/CD8~+、CD8~+改善程度大于对照A、B组,血清IGF-1、IL-6、TNF-α、S100B、NSE改善程度大于对照A、B组,差异均有统计学意义(P <0. 05)。三组患儿不良反应发生率比较,差异无统计学意义(P> 0. 05)。结论重组人干扰素α-1b联合大剂量丙种球蛋白治疗重症HFMD并病毒性脑炎患儿疗效显著,能显著提高患儿免疫功能,减轻机体炎性反应,缓解脑损伤,调节IGF-1水平。
Objective To investigate the clinical effect of recombinant human interferon α-1 b combined with high-dose gamma globulin on children with severe hand-foot-mouth disease( HFMD) and viral encephalitis. Methods A total of 135 children with HFMD and viral encephalitis from Feb 2014 to April 2017 in Yibin Second People's Hospital were randomly divided into control group A( recombinant human interferon α-1 b) and control group B( high-dose gamma globulin) and observation group( recombinant human interferon α-1b + high-dose gamma globulin) according to the random number table method,with 45 cases in each group. The therapeutic effects,serum insulin-like growth factor-1( IGF-1),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),S100 B,neuro-specific enolase( NSE) levels and changes in serum T cell subsets were compared among the three groups. Results The total effective rate of observation group( 93. 33%) was higher than that of control group A and B( 73. 33%,73. 56%)( P < 0. 05). After treatment,the improvement of CD3 +,CD4 +,CD4 +/CD8 + and CD8 + was higher than that of control group A and B( P < 0. 05); the improvement of serum IGF-1,IL-6,TNF-α,S100 B and NSE in observation group was higher than that in control group A and B( P < 0. 05); there was no significant difference in the incidence of adverse reactions among three groups( P > 0. 05). Conclusions The clinical effect of children with severe HFMD and viral encephalitis treated by recombinant human interferon α-1b combined with high-dose gamma globulin is significant. It can significantly improve the immune function of the children,reduce the inflammatory response,alleviate brain damage and regulate the level of IGF-1.
Objective To investigate the clinical effect of recombinant human interferon α-1 b combined with high-dose gamma globulin on children with severe hand-foot-mouth disease( HFMD) and viral encephalitis. Methods A total of 135 children with HFMD and viral encephalitis from Feb 2014 to April 2017 in Yibin Second People's Hospital were randomly divided into control group A( recombinant human interferon α-1 b) and control group B( high-dose gamma globulin) and observation group( recombinant human interferon α-1b + high-dose gamma globulin) according to the random number table method,with 45 cases in each group. The therapeutic effects,serum insulin-like growth factor-1( IGF-1),interleukin-6( IL-6),tumor necrosis factor-α( TNF-α),S100 B,neuro-specific enolase( NSE) levels and changes in serum T cell subsets were compared among the three groups. Results The total effective rate of observation group( 93. 33%) was higher than that of control group A and B( 73. 33%,73. 56%)( P < 0. 05). After treatment,the improvement of CD3 +,CD4 +,CD4 +/CD8 + and CD8 + was higher than that of control group A and B( P < 0. 05); the improvement of serum IGF-1,IL-6,TNF-α,S100 B and NSE in observation group was higher than that in control group A and B( P < 0. 05); there was no significant difference in the incidence of adverse reactions among three groups( P > 0. 05). Conclusions The clinical effect of children with severe HFMD and viral encephalitis treated by recombinant human interferon α-1b combined with high-dose gamma globulin is significant. It can significantly improve the immune function of the children,reduce the inflammatory response,alleviate brain damage and regulate the level of IGF-1.
引文
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[9]邱慧明,朱祎宏.重组人干扰素联合痰热清注射液治疗小儿重症手足口病的临床研究[J].中国临床药理学杂志,2017,33(23):2343-2346.
[10]LIN H,HUANG L,ZHOU J,et al.Efficacy and safety of interferon-α2b spray in the treatment of hand,foot,and mouth disease:a multicenter,randomized,double blind trial[J].Arch Virol,2016,161(11):3073-3080.
[11]占文君.丙种球蛋白联合干扰素治疗重症手足口病患儿的临床效果观察[J].医疗装备,2017,30(17):104-105.
[12]方燕.丙种球蛋白及干扰素治疗手足口病并发病毒性脑炎疗效观察[J].中国实用神经疾病杂志,2015,18(15):30-31.
[13]满宜刚.病毒性脑炎患儿血清和脑脊液IL-6,TNF-α和IGF-1的变化[D].青岛:青岛大学,2003.
[14]李晶,刘瑞海,单若冰.血清S100B蛋白和神经无特异性烯醇化酶预测手足口病严重程度的价值[J].中国当代儿科杂志,2017,19(2):182-187.
[15]GOYAL A,FAILLA M D,NIYONKURU C,et al.S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury[J].J Neurotrauma,2013,30(11):946-957.
[16]覃秋琴,金玉.手足口病的相关研究进展[J].中华传染病杂志,2015,33(9):575-576.
[17]黄海英,陈尚明,刘永华,等.NSE和HMGB1在妊娠高血压病产妇的新生儿脑损伤中的诊断价值[J].江苏医药,2016,42(1):44-46.
[2]赵奇,朱俊萍.中国手足口病的流行状况及病原谱变化分析[J].病毒学报,2015,31(5):554-559.
[3]LU Q B,ZHANG X A,WO Y,et al.Circulation of coxsackievirus A10 and A6 in hand-foot-mouth disease in China,2009-2011[J].PLo S One,2012,7(12):e52073.
[4]张瑜,谢燕,袁娟,等.雾化吸入IFN-α1b对重症手足口病脑保护作用的研究[J].中国妇幼健康研究,2017,28(9):1071-1074.
[5]中华人民共和国卫生部.手足口病诊疗指南(2010版)[J].中国实用乡村医生杂志,2012,19(19):9-11.
[6]杨晓泉,叶晓明,农少云,等.手足口病患儿的免疫功能[J].中华实用儿科临床杂志,2011,26(22):1764-1764.
[7]HUANG Q,WANG Y,SI C,et al.Interleukin-35 modulates the imbalance between regulatory T cells and T helper 17 cells in enterovirus 71-induced hand,foot,and mouth disease[J].J Interferon Cytokine Re,2017,37(12):522-530.
[8]SHEN J,ZHAO C,CAO P,et al.Relationship between serologic response and clinical symptoms in children with enterovirus 71 infected hand-foot-mouth disease[J].Int J Clin Exp Pathol,2015,8(9):11608-11614.
[9]邱慧明,朱祎宏.重组人干扰素联合痰热清注射液治疗小儿重症手足口病的临床研究[J].中国临床药理学杂志,2017,33(23):2343-2346.
[10]LIN H,HUANG L,ZHOU J,et al.Efficacy and safety of interferon-α2b spray in the treatment of hand,foot,and mouth disease:a multicenter,randomized,double blind trial[J].Arch Virol,2016,161(11):3073-3080.
[11]占文君.丙种球蛋白联合干扰素治疗重症手足口病患儿的临床效果观察[J].医疗装备,2017,30(17):104-105.
[12]方燕.丙种球蛋白及干扰素治疗手足口病并发病毒性脑炎疗效观察[J].中国实用神经疾病杂志,2015,18(15):30-31.
[13]满宜刚.病毒性脑炎患儿血清和脑脊液IL-6,TNF-α和IGF-1的变化[D].青岛:青岛大学,2003.
[14]李晶,刘瑞海,单若冰.血清S100B蛋白和神经无特异性烯醇化酶预测手足口病严重程度的价值[J].中国当代儿科杂志,2017,19(2):182-187.
[15]GOYAL A,FAILLA M D,NIYONKURU C,et al.S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury[J].J Neurotrauma,2013,30(11):946-957.
[16]覃秋琴,金玉.手足口病的相关研究进展[J].中华传染病杂志,2015,33(9):575-576.
[17]黄海英,陈尚明,刘永华,等.NSE和HMGB1在妊娠高血压病产妇的新生儿脑损伤中的诊断价值[J].江苏医药,2016,42(1):44-46.