不同剂量丙种球蛋白联合糖皮质激素治疗小儿中重度急性吉兰-巴雷综合征的疗效比较  

Clinical efficacy of different doses of gamma globulin combined with glucocorticoid in treatment of moderate/severe acute Guillain-Barré syndrome in children: a comparative analysis

作　　者：马小云 李昭 王雪君 冶建军 马永平 李瀛[3] MA Xiao-Yun LI Zhao WANG Xue-Jun YE Jian-Jun MA Yong-Ping LI Ying(Department of Pediatric Neurology, Women＇s and Children＇s Hospital of Qinghai, Xining 810000, China)

机构地区：[1]青海省妇女儿童医院小儿神经内科,青海西宁810000 [2]青海省妇女儿童医院妇产科,青海西宁810000 [3]海口市人民医院神经科,海南海口570208

出　　处：《中国当代儿科杂志》2016年第12期1286-1290,共5页Chinese Journal of Contemporary Pediatrics

基　　金：青海省卫生计生科研指导性计划(ASRF-2015-19);海南省自然科学基金项目(81266);青海大学附属医院中青年科研项目(2014-QYY-16)

摘　　要：目的观察并比较静脉注射小剂量丙种球蛋白与大剂量丙种球蛋白联合糖皮质激素冲击治疗小儿中重度急性吉兰-巴雷综合征(GBS)的临床疗效与安全性。方法将100例中重度急性GBS患儿随机分为小剂量组(48例)和大剂量组(52例)。小剂量组和大剂量组分别采用0.2 g/(kg·d)和0.4 g/(kg·d)丙种球蛋白联合甲基强的松龙治疗。比较治疗后两组症状改善时间、外周血炎性因子水平的变化、有创通气比例、治疗有效性及不良反应。结果治疗5 d后,小剂量组和大剂量组血清TNF-α、IL-6、CRP水平均较治疗前明显下降,两组TNF-α、IL-6、CRP下降幅度差异均无统计学意义。两组患儿呼吸机麻痹恢复时间、肌力提升1级时间、感觉障碍恢复时间及住院时间比较差异均无统计学意义。小剂量组和大剂量组总体有效率(90%vs 92%)比较差异无统计学意义。两组患儿发热、头痛、恶心、心慌发生率比较差异均无统计学意义。结论小剂量与大剂量丙种球蛋白联合甲基强的松龙冲击治疗小儿中重度急性GBS临床疗效与安全性相当。Objective To investigate the clinical efficacy and safety of intravenous injection of low-dose versus high-dose gamma globulin combined with glucocorticoid pulse therapy in the treatment of children with moderate/severe acute Guillain-Barré syndrome（GBS）.Methods A total of 100 children with moderate/severe acute GBS were randomly assigned to low-dose group（n=48） and high-dose group（n=52）.The children in the low-dose and high-dose groups were treated with 0.2 g/（kg · d） and 0.4 g/（kg · d） gamma globulin respectively combined with methylprednisolone.The two groups were compared in terms of the time to improvements of symptoms after treatment,serum levels of inflammatory factors,proportion of children undergoing invasive ventilation,treatment response rate,and adverse events.Results After 5 days of treatment,the low- and high-dose groups had significant reductions in serum levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein,and there were no significant differences in the reductions of these markers between the two groups.There were no significant differences between the two groups in the time to recovery of respiratory muscle paralysis,time to an improvement in muscle strength of one grade,time to recovery of sensory disturbance,and length of hospital stay.There was no significant difference in the treatment response rate between the low- and high-dose groups（90% vs 92%）.There were also no significant differences in the incidence rates of pyrexia,headache,nausea,and palpitation between the two groups.Conclusions Low-dose versus high-dose gamma globulin combined with methylprednisolone pulse therapy have comparable clinical efficacy and safety in the treatment of children with moderate/severe acute GBS.

关 键 词：吉兰-巴雷综合征 丙种球蛋白 糖皮质激素 炎性因子 儿童 

分 类 号：R745.43[医药卫生—神经病学与精神病学]