丙种球蛋白对重症EV71感染手足口病患儿细胞因子调节作用的研究  

Change of Serum Cytokines by Intravenous Gammaglobulin in Severe Enterovirus 71-associated Hand-foot-mouth Disease

作　　者：李素华[1] 陈雪夏[1] 林海龙[1] 汪洪姣[1] 夏蝉[1] 陈益平[1] 

机构地区：[1]温州医学院附属儿童医院,325027

出　　处：《医学研究杂志》2013年第6期111-115,共5页Journal of Medical Research

基　　金：温州市科技局基金资助项目(Y20110140)

摘　　要：目的研究静脉注射用丙种球蛋白(IVIG)对重症EV71感染相关手足口病外周血细胞因子的调节作用。方法根据病情将治疗组患儿分成3组,脑膜脑炎组(ME组)14例、自主神经功能失调组(ANSD组)13例,肺水肿组(PE组)12例,均在入院12h内给予IVIG〔1g/(kg.d),2天〕治疗。并设普通手足口病对照组(HFMD组)10例,给予一般治疗。比较治疗组患儿IVIG治疗前后血清中细胞因子TNF-α、IL-2、IL-10、IL-13、IL-6以及INF-γ水平的变化,及各组间年龄、发热时间、血糖、外周血白细胞计数、血清细胞因子水平及T淋巴细胞亚群的差异。结果在IVIG使用前后,ME组患儿各细胞因子无明显改变,ANSD组患儿IL-13、IL-6明显下降(P<0.05),PE组患儿IL-10、IL-13、IL-6、INF-γ明显下降(P<0.05)。各组之间比较,随着病情加重,血清中细胞因子IL-10、IL-6、IL-13浓度逐渐升高;血糖、白细胞计数同PE组比较有统计学差异(P<0.05),同时外周血CD4/CD8比值、NK细胞比例PE组下降最为明显,差异有统计学意义(P<0.05)。结论 IVIG治疗可调节危重症手足口病患儿的免疫功能,及时使用可改善预后。Objective To study the serum levels change of cytokines in severe enterovirus 71 - associated hand foot and mouth disease （HFMD） by intravenous immunoglobulin （1VIG） therapy. Methods A total of 49 patients were included in the study. Thirty - nine patients had severe HFMD including 14 eases of meningoencephalitis （ME group）, 13 autonomic dysfunction group （ANSD group） and 12 pulmonary edema group （PE group） , while 10 common HFMD patients served as control subjects. Serum levels of TNF -α,IL- 2 ,IL - 10 ,IL - 13 ,IL - 6 ,INF -γ in the patients were measured before and after IVIG [1g/（ kg · d） , 2day]. Complete blood count, fast- ing plasma glucose,T lymphocyte subsets were determined, and age was recorded in the four groups,then the changes in different groups were compared. Results The serum levels of IL - 13 and IL - 6 were lower in ANSD group（ P 〈 0. 05 ） , and the IL - 10, IL - 13, IL - 6 and INF -γ reduced significantly in PE group （P 〈 0.05）. However, serum cytokines levels were similar in ME group both before and after IVIG therapy （ P 〉 0.05 ）. The ages, fever duration time and CRP showed no significant difference in these four groups. When PE group were compared, fasting plasma glucose and white blood cell count were clearly different （ P 〈 0.05 ）. Peripheral blood CD4/CD8 ratio and NK cells were declined. There was statistically significant（ P 〈 0.05 ）. Conclusion These data suggest that IVIG therapy can regulate immune function of the severe HFMD. Early IVIG therapy may be important in improving HFMD prognosis.

关 键 词：静脉注射丙种球蛋白 手足口病 肠道病毒71型 细胞因子 

分 类 号：R714.51[医药卫生—妇产科学]