不同剂量静脉注射人血免疫球蛋白治疗重症手足口病合并脑炎疗效分析

doi:10.3877/cma.j.issn.1673-5250.2013.02.018

目的

探讨3种不同剂量静脉注射人血免疫球蛋白(IVIG)治疗重症手足口病(HFMD)合并脑炎的疗效。

方法

选择2012年6月至2012年9月于本院就诊的75例重症HFMD合并脑炎患儿为研究对象，并按照随机抽签法分为A组(n＝25)，B组(n＝25)和C组(n＝25)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书)。3组患儿除均接受甘露醇、甲泼尼龙琥珀酸钠及对症支持治疗外，还分别接受不同剂量IVIG治疗，具体IVIG治疗方案：A组为1 g/(kg·d)×2 d，B组为500 mg/(kg·d)×2 d，C组为200 mg/(kg·d)×2 d。对3组患儿疗效进行比较。3组患儿年龄、病程、性别等比较，差异无统计学意义(P>0.05)。

结果

A组与B组和C组患儿疗效比较，差异均有统计学意义(P₁<0.05)。而B组和C组患儿疗效比较，差异无统计学意义(P₂>0.05)。

结论

大剂量IVIG治疗重症HFMD合并脑炎，能迅速改善临床症状、缩短病程、阻止病情进展及降低危重并发症发生率，具有较好疗效。

关键词: 静脉注射人血免疫球蛋白, 剂量, 手足口病, 重症, 脑炎

Objective

To explore the curative effect of different doses of intravenous immunoglobin(IVIG) in children with severe hand foot and mouth disease(HFMD) combined with encephalitis.

Methods

From June to September 2012, 75 children with severe HFMD combined with encephalitis were included in the study, and randomly divided into group A(n=25), group B(n=25)and group C(n=25). Besides mannitol, methylprednisolone and other supportive treatments, different doses of IVIG were given in three groups respectively. The curative effect was compared among three groups.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of People's Hospital of Jimo.Informed consent was obtained from each parents. There was no significant difference in age, disease course and sex among three groups (P>0.05).

Results

There had significant differences in curative effect among three groups(P₁<0.05). There was no significant difference in curative effect between group B and group C(P₂>0.05).

Conclusions

High-dose IVIG was effective to children with severe HFMD combined with encephalitis, it can relief the symptoms quikly, shorten the course of the disease, avoid the progress of the disease and decrease the incidence rate of complications.

Key words: intravenous immunoglobin, dose, hand foot and mouth disease, severe case, encephalitis

表1 3组患儿一般资料比较(±s)

Table 1 Comparison of general condition among three groups(±s)

组别	n	性别[n(%)]		年龄(岁)	病程(d)
组别	n	男	女	年龄(岁)	病程(d)
A组	25	15(60.0)	10(40.0)	1.78±0.85	2.60±0.50
B组	25	12(48.0)	13(52.0)	1.92±1.21	2.48±0.51
C组	25	14(56.0)	11(44.0)	2.38±0.94	2.40±0.50
χ²/F		0.365		2.367	1.000
P		0.695		0.101	0.373

表1 3组患儿一般资料比较(±s)

Table 1 Comparison of general condition among three groups(±s)

组别	n	性别[n(%)]		年龄(岁)	病程(d)
组别	n	男	女	年龄(岁)	病程(d)
A组	25	15(60.0)	10(40.0)	1.78±0.85	2.60±0.50
B组	25	12(48.0)	13(52.0)	1.92±1.21	2.48±0.51
C组	25	14(56.0)	11(44.0)	2.38±0.94	2.40±0.50
χ²/F		0.365		2.367	1.000
P		0.695		0.101	0.373

表2 3组患儿临床疗效比较(h，±s)

Table 2 Comparison of clinical effect among three groups(h，±s)

组别	n	发热缓解时间	肢体抖动缓解时间	精神恢复时间	临床治愈时间	治疗无效患者数[n(%)]
A组	25	2.32±0.48	2.20±0.41	3.28±0.46	6.12±0.60	0(0.0)
B组	25	3.04±0.54	3.56±0.50	4.12±0.60	8.12±0.62	2( 8.0)
C组	25	3.08±0.57	3.68±0.45	4.20±0.65	8.52±0.65	6(24.0)
F/χ²		16.269	80.551	19.473	106.776	4.200
P₁		<0.01	<0.01	<0.01	<0.01	<0.05
t		0.253	0.881	0.419	1.089	1.445
P₂		0.802	0.387	0.679	0.083	0.163

表2 3组患儿临床疗效比较(h，±s)

Table 2 Comparison of clinical effect among three groups(h，±s)

组别	n	发热缓解时间	肢体抖动缓解时间	精神恢复时间	临床治愈时间	治疗无效患者数[n(%)]
A组	25	2.32±0.48	2.20±0.41	3.28±0.46	6.12±0.60	0(0.0)
B组	25	3.04±0.54	3.56±0.50	4.12±0.60	8.12±0.62	2( 8.0)
C组	25	3.08±0.57	3.68±0.45	4.20±0.65	8.52±0.65	6(24.0)
F/χ²		16.269	80.551	19.473	106.776	4.200
P₁		<0.01	<0.01	<0.01	<0.01	<0.05
t		0.253	0.881	0.419	1.089	1.445
P₂		0.802	0.387	0.679	0.083	0.163

[1]	Chen SC, Chang HL, Yan TR, et al.An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan[J]. Am J Trop Med Hyg, 2007, 77(1):188-191.
[2]	Wang SM, Liu CC. Enterovirus 71:Epidemiology, pathogenesis and management[J]. Expert Rev Anti Infect Ther, 2009, 7(6):735-742.
[3]	Ministry of Health of the People's Republic of China.Diagnosis and treatment guideline on hand-foot-mouth disease(2010)[J]. Int J Respir, 2010, 30(24):1473-1475.
[4]	Ministry of Health of the People's Republic of China.Diagnosis and treatment guideline on hand-foot-mouth disease(2008)[J]. Herald Med, 2009, 28(3):404-406.
[5]	Cao DZ, Fu D, He YX, et al. Clinical features of 80 severe cases of hand-foot-mouth disease of Shenzhen in 2008[J].Chin Pediatr Emerg Med, 2009, 16(2):145-148.
[6]	Nolan MA, Craig MM, Lahra MM, et al.Survival after pulmonary edema due to enterovirus 71 encephalitis[J]. Neurology, 2003, 60:1651-1656.
[7]	Du CQ, Wu Q, Wang MF, et al.Etiological study and clinical treatment in children with hand foot and mouth disease[J/CD].Chin J Obstet Gynecol Pediatr:Electron Ed, 2012, (1):60-63.
[8]	Lin TY, Chang LY, Huang YC, et al.Different proinflammatory reactions in fatal and non-fatal enterovirus 71 infection:Implicalions for early recognition and therapy[J].Acta Paediatr, 2002, 91(6):632-635.
[9]	Liu YX, Zhou BP. New progress on hand, foot and mouth disease caused by enterovirus 71[J/CD].Chin J Exp Clin Infect Dis: Electron Ed, 2010, 4(1):71-75.
[10]	Chen DY, Huang XW. Analysis on testing serum immunoglobulins and hs-CRP in children with hand-foot-mouth disease[J]. Chin Gener Pract, 2011, 14(2):476-477.
[11]	Du BY, Bai L, Shen Y, et al. The effects of enterovirus 71 infection on the ability of t cellular immunity[J].J Med Res, 2010, 39(8):50-53.
[12]	Chen XN. Theoretical guidance on diagnosis and treatment of severe virus infectious disease with SIRS/sepsis according to the hand, foot and mouth disease[J]. Chin Pediatr Emerg Med, 2010, 17(1):87-88.
[13]	Cao RY, Han JF, Qin E, et al. Mechanism of intravenous immunoglobulin therapy for severe hand-foot-mouth disease:A review[J]. Chin J Biotechnol, 2011, 27(5):712-716.
[14]	Cao R, Han J, Deng Y, et al.Presence of high-titer neutralizing antibodies against enterovirus 71 in intravenous immunoglobin manufactured from Chinese donors[J].Clin Infect Dis, 2010, 50(1):125-126.
[15]	Kaneko Y, Nimmerjahn F, Ravetch JV.Anti-inflammatory activity of immunoglobin G resulting from Fc sialylation[J].Science, 2006, 313(5787):670-673.
[16]	Hemming VG.Use of intravenous immunoglobin for prophylaxis or treatment of infectious diseases[J].Clin Diagn Lab Immunol, 2001, 8(5):859-863.
[17]	Mouthon L, Lortholary O. Intravenous immunoglobins in infectious diseases:Where do we stand[J]？Clin Microbiol Infect, 2003, 9(5):333-338.
[18]	Wang SM, Lei HY, Huang MC, et al.Modulation of cytokine production by intravenous immunoglobin in patients with enterovirus 71-associated brainstem encephalitis[J].J Clin Virol, 2006, 37(1):47-52.
[19]	Wang SM, Ho TS, Shen CF, et al. Enterovirus 71, one virus and many stories[J].Pediatr Neonatol, 2008, 49(4):113-115.

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Curative Effect Analysis of Different Doses of Intravenous Immunoglobin for Children With Severe Hand Foot and Mouth Disease Combined With Encephalitis

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Curative Effect Analysis of Different Doses of Intravenous Immunoglobin for Children With Severe Hand Foot and Mouth Disease Combined With Encephalitis