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目的对比更昔洛韦分别联合神经节苷脂和丙种球蛋白治疗小儿病毒性脑炎的临床效果及安全性。方法选取2010年1月—2015年12月收治的124例小儿病毒性脑炎患者,随机分为观察1组(42例)、观察2组(43例)及对照组(39例)。观察1组给予更昔洛韦联合神经节苷脂治疗,观察2组给予更昔洛韦联合丙种球蛋白治疗,对照组单纯给予更昔洛韦治疗,比较3组患者临床疗效,血清神经元特异性烯醇化酶(NSE)及炎症因子水平。结果观察1组的总有效率为95.24%,观察2组的总有效率为93.02%,均显著高于对照组的总有效率(79.48%);观察组(1、2)的头痛、发热、惊厥、意识模糊、脑膜刺激征、脑脊液异常等临床症状消失时间以及住院天数均显著短于对照组(P<0.05);观察1组在惊厥、意识模糊消失时间上显著短于观察2组。治疗后,3组患者血清中NSE水平均较治疗前明显降低(P<0.05),且观察组(1、2)患者血清NSE水平显著低于对照组(P<0.05);观察1组的NSE水平与正常对照组无差异;观察2组的NSE水平显著高于正常组(P<0.05)。3组患者血清中白介素6(IL-6)、白介素1β(IL-1β)的水平均较治疗前明显降低(P<0.05),且观察组(1、2)患者血清炎症因子水平明显低于对照组(P<0.05)。结论更昔洛韦联合神经节苷脂和更昔洛韦联合丙种球蛋白两种方案均是治疗小儿病毒性脑炎的有效措施,均能有效降低机体炎症反应,更昔洛韦联合神经节苷脂具有更好的修复神经损伤的功效,值得临床推广。
Objective To compare the clinical efficacy and safety of ganciclovir with ganglioside and gamma globulin in the treatment of pediatric viral encephalitis. Methods A total of 124 children with viral encephalitis admitted from January 2010 to December 2015 were randomly divided into observation group 1 (42 cases), observation group 2 (43 cases) and control group (39 cases). Group 1 was treated with ganciclovir combined with ganglioside, ganciclovir combined with gamma globulin was given in two groups, ganciclovir alone was given in the control group, and clinical efficacy, serum neuron-specific Enolase (NSE) and inflammatory cytokines levels. Results The total effective rate in observation group 1 was 95.24%. The total effective rate in observation group 2 was 93.02%, which was significantly higher than that of control group (79.48%). The headache, fever, Convulsions, confusion, meningeal irritation, cerebrospinal fluid abnormalities such as disappearance of clinical symptoms and hospitalization days were significantly shorter than the control group (P <0.05); observation group 1 in convulsion, confusion disappear time was significantly shorter than the observation group 2. After treatment, the levels of NSE in serum of three groups were significantly lower than those before treatment (P <0.05), and the level of serum NSE in observation group (1,2) was significantly lower than that in control group (P <0.05) The level of NSE in the two groups was significantly higher than that in the normal group (P <0.05). Serum levels of IL-6 and IL-1β in three groups were significantly lower than those before treatment (P <0.05), and the levels of serum inflammatory cytokines in the observation group (1,2) were significantly lower than those in the control group Control group (P <0.05). Conclusion Both ganciclovir combined with ganglioside and ganciclovir combined with gamma globulin are effective measures for the treatment of viral encephalitis in children and both can effectively reduce the inflammatory reaction in the body. Ganciclovir combined with ganglioside Lipid has a better effect of repairing nerve damage, it is worth clinical promotion.