大剂量静脉注射免疫球蛋白对新生儿肺炎患儿T、 B细胞功能的抑制作用  

Suppressive effects of high dose IVIG on functions of T and B lymphocyte of neonates with pneumonia

作　　者：赵晓东[1] 李世红[1] 王莉佳[1] 杨锡强[1] 李永柏[1] 徐天鹤[1] 罗洪琦[2] 

机构地区：[1]重庆医科大学儿童医院,400014 [2]四川省自贡市晨光化工研究所职工医院

出　　处：《儿科药学》2000年第3期11-13,共3页Journal of Pediatric Pharmacy

摘　　要：目的 观察两种剂量静脉注射免疫球蛋白(Intravenous immunoglobulin,IVIG)对新生儿肺炎患儿的疗效及其免疫抑制作用,为IVIG在新生儿肺炎的应用提供依据.方法 随机选取41例新生儿肺炎患儿,分为对照组,500~700mg/kg IVIG组及1000~1200mg/kg IVIG组,后两组分别于病程之l^4天接受IVIG治疗,其余治疗方法三组同.观察疗效并检测治疗前后患儿血清IgG、IgA、IgM、IgG亚类,T、B细胞增殖反应,外周血单个核细胞产生IgG亚类、IL-2、IL-4及IL-6能力.结果 两种剂量IVIG组患儿临床恢复情况与对照组相比无显著差异.与对照组比较,大剂量IVIG组治疗后血清IgG及IgG亚类水平明显升高,但其T、B细胞增殖反应、PBMC产生IL-2及IgG1、IgGZ2、IgG3水平明显下降.对照组治疗前后各指标均无明显变化.结论 IVIG对新生儿肺炎似无明显疗效,大剂量使用IVIG可能因其至少短期内具有抑制T、B细胞功能作用而加重新生儿期暂时免疫缺陷,故建议应据新生儿的免疫系统功能状态针对性选用IVIG.ve To observe the therapeutic and immunosuppressive effects of intravenous immunoglobulin(IVIG) in neonates with pneumonia. Methods Forty - one (Generation ranged from 36 to 41 weeks) neonates with pneumonia were randomly divided into 3 groups, with 20 neonates in control group, 15 neonates in group of lower dose IVIG in which 500 - 700mg/kg IVIG infused and 6 neonates in group of higher dose IVIG in which 1000 - 1200mg/kg IVIG infused, respectively. IVIG was administered during the 1stto 4th day of the disease onset. Serum IgG, IgM, IgAand IgG subclasses, proliferation of T and B lymphocytes, IL - 2, IL - 4and IL - 6 produced by PBMC in vitro, IgG subclass levels in PBMC culture supernatants were detected by ELISA and 3H - TdR incorporation assay respectively before and 2-4 days after IVIG treatment. Results There is no clinical differentiation in all neonates with pneumonia to be observed. Serum IgG and IgG subclass levels in two IVIG groups increased markedly. However, proliferation of T and B lymphocyte, IL - 2, IgGl, IgG2 and IgG3 production in higher dose IVIG group decreased significantly after IV IG treatment compared with other groups. Conclusion It's unlikely that IVIG treatment in favor of neonatal pneumonia. Due to its suppressive effects on functions of T and B lymphocytes at least in short term, we advise that its uses in neonatal infections be decided by the functional situation of neonate's immune system and abusing of IVIG be forbidened.

关 键 词：新生儿肺炎 免疫球蛋白 T细胞 B细胞 免疫抑制 

分 类 号：R722.135[医药卫生—儿科] R979.5[医药卫生—临床医学]