大剂量人血丙种球蛋白冲击治疗重症传染性单核细胞增多症疗效观察  

Effect of high dose intravenous immunoglobulin on treat severe infectious mononucleosis cases with implosive therapy

作　　者：黄娟[1] 芦映红[1] 吴亚斌[1] 陆丹[2] 

机构地区：[1]湖北省妇幼保健院儿科,武汉430070 [2]湖北省妇幼保健院检验中心

出　　处：《临床血液学杂志》2011年第5期526-529,共4页Journal of Clinical Hematology

摘　　要：目的:观察大剂量静脉用丙种球蛋白(IVIG)治疗重症传染性单核细胞增多症(severe infectiousmononucleosis,sIM)疗效。方法:2007—2009年我院重症监护病房收治sIM患者47例,随机分为干扰素(IFN)组和IVIG组(IFN加大剂量IVIG);在治疗后第3、7及14天分别再次检测血常规、肝功能、心肌酶谱、血清铁蛋白、凝血功能等指标,并在第14天比较2组疗效。结果:治疗后第3天IVIG组已有21例(84.0%)体温降至正常,而IFN组体温无下降;除3-test、D-二聚体、CK-MB外,IVIG组在体温、血常规、AST、ALT、LDH、CK及SF的改善上与IFN组相比均差异有统计学意义(均P<0.05);治疗后第7天,IVIG组在体温稳定性、血常规、ALT、LDH及SF的恢复上与IFN组相比均差异有统计学意义(均P<0.05);治疗后第14天,IVIG组有效率88.0%,IFN组有效率63.6%,前者显效率及有效率明显好于后者(P<0.05)。结论:大剂量IVIG冲剂疗法是治疗sIM的有效方法;有部分sIM可发展为EBV-相关噬血淋巴组织增生症(EBV-HLH),应加强监测,对于已发展为EBV-HLH的患儿,大剂量IVIG冲击治疗是由否有效尚需进一步研究。Objective：To evaluate the effect of high dose intravenous immunoglobulin in treating severe infectious mononucleosis cases.Method：Fourty-seven severe infectious mononucleosis cases randomly divided into IFN group and IVIG group.INF group was injected with INF-γ;IVIG group was injected with INF-γ plus high dose of intravenous immunoglobulin within two days.Observing the temperature and redetecting the blood routine,ALT,AST,LDH,CK,CK-MB,3-T test,D-dimer,serum ferritin（SF）on 3 day,7day and 14 day after treatment.Result：Three days after treatment,body temperature in 21 cases of IVIG group returned to normal（84.0%）,while no case in the control group;in addition,excent for 3-test,D-dimer and CK-MB,there were significantly different in body temperature,blood Rt,AST,ALT,LDH,CK,and improvements SF in IVIG group,compared to the IFN group.Seven days after treatment,the IVIG group was significantly different the control group from in stabling of body temperature,blood Rt,ALT,LDH and recovery of SF.Fourteen days after treatment,the efficiency of the IVIG group was 88.0% while the IFN group was 63.6%,IVIG group was better than the IFN group（P〈0.05）.Conclusion：High dose of IVIG injection with implosive therapy was an effective way to treat severe IMs.Some sIM could progress to EBV-HLH.It is necessory to strengthen monitoring the impact of high-dose IVIG on IBV-HLH in further investigation.

关 键 词：丙种球蛋白 大剂量 单核细胞增多症 传染性 重症 冲击疗法 

分 类 号：R725.5[医药卫生—儿科]