更昔洛韦联合干扰素-α1b雾化吸入治疗儿童传染性单核细胞增多症的疗效  

Curative effect of Ganciclovir combined with interferon -α1b inhalation in treating children with infectiousmononucleosis

作　　者：单鸣凤[1] 胡静[1] 穆原[2] 周凯[1] 田野[1] 夏晨[1] 

机构地区：[1]南京医科大学附属儿童医院感染科,210008 [2]南京医科大学附属儿童医院检验科,210008

出　　处：《中华实用儿科临床杂志》2017年第15期1174-1178,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：汀苏省人社厅资助项目（2016-WSN-193）

摘　　要：目的探讨更昔洛韦联合干扰素-α1b雾化吸入治疗儿童传染性单核细胞增多症（IM）的临床疗效和安全性。方法选取IM患儿177例，采用随机数字表法分为3组，每组59例，分别选用更昔洛韦静脉滴沣（A组）、更昔洛韦静脉滴注＋f扰素-α1b雾化吸入（B组）和更昔洛韦静脉滴注＋干扰素-α1b肌肉注射（c组）3种治疗方法治疗5～7d。比较各组患儿用药后热退时间、咽峡炎好转时间、异型淋巴细胞〈0．05时间、颈部淋巴结缩时间、肝回缩时间、脾回缩时间及治疗前后EB病毒（EBV）-DNA拷贝数和T淋巴细胞亚群；同时观察治疗过程中各组出现的不良反应。结果与A组比较，B组、C组在热退时间[（3．20±1．81）d、（3．17±1．76）d比（4．（11±2．34）d]、咽峡炎好转时间[（3．15±1．33）d、（3．09±1．37）d比（3．98±1．31）d]、异型淋巴细胞〈0．05时间[（3．12±1．55）d、（3．10-4-1．33）d比（3．95±1．26）d]明显缩短，差异均有统计学意义（F：4．150、4．580、4．060，均P〈0．05），治疗7d后EBV—DNA阴转率均高于A组[53例（89．8％）、52例（88．1％）比41例（69．5％），x2=10．403，P〈0．05]，在治疗后7d细胞免疫功能的恢复上差异明显[CD3＋：（63．00±4．39）％、（62．75±4．84）％比（68．70±7．70）％，CD4＋：34．08（30．21，41．70）％、33．94（29．17，45．17）％比32．34（28．16，43．53）％，CD8＋30．59（27．14，40．22）％、30．09（27．54，40．48）％比32．57（28．68，41．17）％，CIM＋／CD8＋1．12（1．03，1．31）、1．11（0．99，1．64）比0．94（0．87，1．59），F/x2=11．020、1．217、1．121、6．728，均P〈0．05]。B组和C组间比较各项指标变化差异不明显，差异均无统计学意义（均P〉0．05）。小良反应方面：C组出现2例发热，每组均出现2例粒细胞减少。结论更昔洛韦联合干扰素-α1b雾Objective To investigate the clinical efficacy and safety of Ganciclovir combined with interferon -α1b inhalation for children with infectious monouucleosis（IM）. Methods A total of 177 childhood cases of IM were selected,and they were divided into 3 groups,59 cases in each group according to the random number table. Three the- rapeutic methods were applied in different groups for 5 - 7 days in different groups ： Ganciclovir （ group A ） , Gancielovir ± interferon- a l b inhalation （group B） and Ganeiclovir ± interferon-α1b intramuscularly （group C）. The time of post - drug recovery from isthmitis, less than 0.05 of heterotypic lymphocytes, shrink of cervical lymph nodes shriuk,liver retraction,spleen retraction among groups were compared. The Epstein - Barr virus （EBV） - DNA copy number and T lymphocyte subsets were compared before and after treatment. Adverse reactions were observed in each group. Results Compared with group A, the time to defervescence [ （3.20 ± 1.81 ） d, （3. 17 ± 1.76） d vs. （4.01 ± 2.34） d ,duration of isthmitis was （3.15 ± 1.33 ） d, （3.09 ± 1.37） d vs. （3.98 ± 1.31 ） d] ,and the time of heterotypic lymphocytes less than 0.05 [ （3.12 ± 1.55 ） d, （3.10 ± 1.33 ） d vs. （ 3.95 ± 1.26） d ] in group B and group C, were obvious shorter, and there were significant differences （F = 4. 150,4. 580,4. 060, all P 〈 0.05 ）. EBV - DNA negative conversion rate of group B and group C were higher than that of group A [53 cases（ 89.8% ） ,52 cases （88. 1% ） vs. 41 cases （ 69.5% ） ,X2 = 10. 403, P 〈 0.05 1 , and the cellular immune function was improved signi- ficantly than that of group A afler treatment for 7 days [ CD3 ± ： （63.00 ± 4.39 ） % , （ 62.75 ± 4.84 ） % vs. （ 68.70 _± 7.70）% ;CD4± ：34.08（30.21,41.70）% ,33.94（29. 17,45.17）% vs. 32.34（28. 16,43.53）% ;CD8± ：30.59 （27.14,40.22）%,30.09（27.54,40.48）% vs. 32.57（28.68,41.17）%;CD4±/CD8±：1.12（l.03,1.31）,1.11 （0.99,

关 键 词：传染性单核细胞增多症 更昔洛韦 干扰素-Α1B 雾化吸入 

分 类 号：R725.1[医药卫生—儿科]