免疫球蛋白改善新生儿缺氧缺血性脑病患者意识、肌张力障碍  

Effect of intravenous immunoglobulin therapy to improve consciousness disturbance and abnormal muscular tone in neonates with hypoxic ischemic encephalopathy

作　　者：杜冀晖 苏卓娃 乐新 陈实[2] 

机构地区：[1]深圳市南山人民医院中心实验室,广东省深圳市518052 [2]深圳市南山区妇幼保健院,广东省深圳市518052

出　　处：《中国临床康复》2003年第16期2340-2341,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的探讨静脉注射免疫球蛋白(IVIG)改善新生儿缺氧缺血性脑病(HIE)患者意识、肌张力障碍的临床疗效及其作用机制。方法将40例HIE患儿随机分为IVIG治疗组及常规治疗组,比较两组患儿临床症状、体征消失及住院时间;并采用ELISA法检测患儿治疗前后外周血单个核细胞(PBMC)产生肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)的水平。结果与常规治疗组相比,IVIG治疗组患儿意识、肌张力障碍等症状消退时间及住院时间较常规治疗组均显著缩短犤(36±11)hvs(55±20)h,(34±18)hvs(50±19)h,(252±37)hvs(280±50)h,t=2.04～3.63,P<0.05犦。IVIG治疗后患儿PBMC产生前炎症细胞因子水平明显低于治疗前犤TNF-α:(1.0±1.6)μg/Lvs(4.2±3.8)μg/L,IL-1β:(1.1±1.5)μg/Lvs(3.4±3.8)μg/L,IL-6:(0.8±1.4)μg/Lvs(3.0±3.2)μg/L,P<0.01犦,而常规治疗前后无明显差异。结论IVIG早期应用对改善HIE患儿意识、肌张力障碍具有较好疗效,可能是通过抑制PBMC产生TNF-α,IL-1β和IL-6等损伤性细胞因子发挥作用。Aim To explore the clinical effects of intravenous immunoglobulin (IVIG) in the treatment of neonates with hypoxic ischemic encephalopathy (HIE) and its mechanisms.Methods Neonates with HIE were divided into two groups of routine and IVIG treatments. The recovery time of various clinical symptoms of HIE and the hospitalization course were investigated. The proinflammatory cytokines (TNF α,IL 1βand IL 6) production in the cultured supernatants of PBMC was determined by ELISA before and after the treatments.Results Compared with the routine treatment group, the recovery time of consciousness disturbance and abnormal muscular tone and the hospitalization course were significantly shortened in IVIG treatment group [(36±11) h vs (55±20) h, (34±18) h vs (50±19) h, (252±37) h vs (280±50) h, P< 0.05]. Levels of proinflammatory cytokines in the supernatant of PBMC after IVIG treatment were much lower than those before IVIG treatment [of TNF α(1.0±1.6)μg/L vs (4.2±3.8) μg/L, of IL 1β(1.1±1.5) μg/L vs (3.4±3.8) μg/L, of IL 6 (0.8±1.4) μg/L vs (3.0±3.2) μg/L,P< 0.01].There were insignificant differences in routine group before and after treatments. Conclusion IVIG has curative effects on consciousness disturbance and abnormal muscular tone in HIE in addition to conventional treatment regimens, which is associated with inhibition of the production of proinflammatory cytokines by PBMC.

关 键 词：免疫球蛋白 新生儿 缺氧缺血性脑病 意识障碍 肌张力障碍 静脉注射 

分 类 号：R722.12[医药卫生—儿科] R977.6[医药卫生—临床医学]