静脉注射人免疫球蛋白治疗45例新生儿红斑狼疮的疗效  

Efficacy of intravenous human immunoglobulin therapy in 45 neonates with neonatal lupus erythematosus

作　　者：张利 米荣[1] 王晓颖[1] 樊子川 李颖[1] 李驰[1] 赖建铭[2] 王亚娟 ZHANG Li;MI Rong;WANG Xiao-ying;FAN Zi-chuan;LI Ying;LI Chi;LAI Jian-ming;WANG Ya-juan(Department of Neonatal Medicine,Children's Hospital of Capital Institute of Pediatrics,BEIJING 100020,China;Department of Rheumatology and Immunology,Children's Hospital of Capital Institute of Pediatrics,BEIJING 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院新生儿内科,北京100020 [2]首都儿科研究所附属儿童医院风湿免疫科,北京100020

出　　处：《中国新药与临床杂志》2023年第6期378-382,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：首都儿科研究所附属儿童医院所级青年科研基金(QN-2020-10)。

摘　　要：目的 观察静脉注射人免疫球蛋白(IVIG)治疗新生儿红斑狼疮(NLE)的疗效。方法 回顾性分析2010年1月至2020年12月在本院接受IVIG治疗的重症NLE患儿的临床资料,包括基本信息和皮疹、发热、血小板减少、溶血性贫血、肝功能异常等临床特征,辅助检查包括血常规、肝功能、抗核抗体谱、心电图、心脏彩超等,并随访观察记录其好转情况。结果 共纳入45例NLE患儿,男性27例,女性18例,平均起病年龄9.86 d。临床表现方面,典型皮疹39例,发热8例,肝功能异常27例,胆汁淤积1例,血液系统损害12例,心脏受累7例。35例(90%)患儿IVIG治疗后皮疹逐渐消退,21例(54%)单用IVIG 4周内皮疹消退,14例(36%)皮疹有所好转加用糖皮质激素后4周内消退。发热的8例患儿应用IVIG后(3.5±2.4)d体温降至正常。肝功能异常的27例患儿在治疗5~7 d后,丙氨酸转氨酶(ALT)有下降趋势[(125.3±82.6) U·L^(-1)vs.(67.9±21.2) U·L^(-1),P=0.08],天冬氨酸转氨酶(AST)显著降低[(139.6±73.5) U·L^(-1)vs.(68.8±28.0) U·L^(-1),P=0.01]。血小板减少的7例患儿中,仅1例单独应用IVIG治疗效果良好,其余6例联合应用了糖皮质激素治疗后血小板恢复正常。心脏受累的7例患儿中有5例为Ⅰ°房室传导阻滞,应用IVIG前后无明显变化。45例患儿均对IVIG耐受性良好,未见严重发热、皮疹、过敏等输血制品不良反应。结论 IVIG对NLE出现的皮疹、肝功能损伤、发热等均有疗效,但是对血小板减少和Ⅰ°房室传导阻滞的疗效不佳。AIM To observe the efficacy of intravenous human immunoglobulin(IVIG)in the treatment of neonatal lupus erythematosus(NLE).METHODS A retrospective analysis was conducted on the clinical data of severe NLE patients who received IVIG treatment in our hospital from January 2010 to December 2020,including basic information,clinical features such as rash,fever,thrombocytopenia,hemolytic anemia,and liver function abnormalities.Auxiliary examinations included blood routine,liver function,antinuclear antibody spectrum,electrocardiogram,and cardiac ultrasound,and follow-up observation was conducted to record their improvement.RESULTS A total of 45 children with NLE were included,including 27 males and 18 females,with an average onset age of 9.86 days.In terms of clinical manifestations,there were 39 cases of typical rash,8 cases of fever,27 cases of abnormal liver function,1 case of cholestasis,12 cases of hematological damage,and 7 cases of cardiac involvement.After IVIG treatment,the rash gradually subsided in 35 children(90%),subsided in 21 cases(54%)within 4 weeks after IVIG alone,and improved in 14 cases(36%)which subsided within 4 weeks after the addition of glucocorticoids.The average body temperature of 8 children with fever decreased to normal(3.5±2.4)days after receiving IVIG.After 5-7 days of treatment,27 children with abnormal liver function showed a decreasing trend in alanine aminotransferase[ALT(125.3±82.6)U·L^(-1)vs.(67.9±21.2)U·L^(-1),P=0.08 J and a significant decrease in aspartate aminotransferase[AST(139.6±73.5 U·L^(-1)vs.(68.8±28.0)U·L^(-1),P=0.01 ].Among the 7 children with thrombocytopenia,only 1 patient received IVIG treatment alone with good results,while the remaining 6 patients received glucocorticoid treatment in combination and their platelets returned to normal.Among the 7 children with cardiac involvement,5 patients had I o atrioventricular block,and there were no significant changes before and after IVIG.Fourty-five children had good tolerance to IVIG,and no adverse reactions,such

关 键 词：婴儿 新生 疾病 红斑狼疮 系统性 免疫球蛋白类 静脉内 

分 类 号：R973[医药卫生—药品]