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目的探讨大剂量甲基泼尼松联合丙种球蛋白对病毒性脑炎儿童神经功能、红细胞及体液免疫功能的影响。方法选取2011—2013年延安大学附属医院收治的病毒性脑炎患儿60例,采用随机数字表法将所有患儿分为对照组和观察组,各30例。对照组患儿给予常规治疗,观察组患儿在对照组基础上给予大剂量甲基泼尼松联合丙种球蛋白治疗;检测两组患儿治疗前后神经功能指标〔血清S100B蛋白、神经元特异性烯醇化酶(NSE)、髓磷脂碱性蛋白(MBP)、神经生长因子(NGF)〕、红细胞免疫功能指标〔C3b受体花环率(RBC-C3bR)、红细胞免疫复合物花环率(RBC-ICR)、跨内皮细胞电阻抗(FEER)〕、体液免疫功能指标(Ig G、Ig M)及红细胞多项指数(红细胞电泳指数、聚集指数、刚性指数)。结果两组患儿治疗前血清S100B蛋白、NSE、MBP、NGF水平比较,差异均无统计学意义(P>0.05);观察组患儿治疗后血清S100B蛋白、NSE、MBP、NGF水平均低于对照组(P<0.05);两组患儿治疗后血清S100B蛋白、NSE、MBP、NGF水平均低于治疗前(P<0.05)。两组患儿治疗前RBC-C3bR、RBC-ICR、FEER比较,差异均无统计学意义(P>0.05);观察组患儿治疗后RBC-C3bR、FEER均高于对照组,RBC-ICR低于对照组(P<0.05);两组患儿治疗后RBC-C3bR、FEER均高于治疗前,RBC-ICR低于治疗前(P<0.05)。两组患儿治疗前电泳指数、聚集指数、刚性指数比较,差异均无统计学意义(P>0.05);观察组患儿治疗后电泳指数、聚集指数、刚性指数均低于对照组(P<0.05);两组患儿治疗后电泳指数、聚集指数、刚性指数均低于治疗前(P<0.05)。两组患儿治疗前Ig G、Ig M比较,差异均无统计学意义(P>0.05);观察组患儿治疗后Ig G、Ig M均低于对照组(P<0.05);两组患儿治疗后Ig G、Ig M均低于治疗前(P<0.05)。结论大剂量甲基泼尼松联合丙种球蛋白可提高病毒性脑炎患儿神经功能、红细胞及体液免疫功能。
Objective To investigate the effect of high dose methylprednisolone combined with gamma globulin on the neurological function, erythrocyte and humoral immune function in children with viral encephalitis. Methods Sixty children with viral encephalitis admitted to Yan’an University Affiliated Hospital from 2011 to 2013 were selected and all the children were divided into control group and observation group with 30 cases in each group by random number table. The control group of children given conventional treatment, the observation group of children in the control group on the basis of high-dose methylprednisolone combined with gamma globulin treatment; test two groups of children before and after treatment of neurological function indicators [serum S100B protein, neuron-specific Enolase (NSE), myelin basic protein (MBP) and nerve growth factor (NGF)), erythrocyte immune function index (C3b receptor rosette rate, RBC-ICR ), Trans-endothelial cell electrical impedance (FEER)], IgM, IgM, and erythrocyte multiple index (erythrocyte electrophoresis index, aggregation index, rigidity index). Results The serum levels of S100B protein, NSE, MBP and NGF in two groups of children before treatment were not significantly different (P> 0.05). The levels of S100B protein, NSE, MBP and NGF in children in observation group were lower than those before treatment (P <0.05). The levels of S100B protein, NSE, MBP and NGF in the two groups were lower than those before treatment (P <0.05). There were no significant differences in RBC-C3bR, RBC-ICR and FEER between the two groups before treatment (P> 0.05). The RBC-C3bR and FEER in the observation group were higher than those in the control group (P <0.05). The RBC-C3bR and FEER in both groups were significantly higher than those before treatment and RBC-ICR was lower than before treatment (P <0.05). There was no significant difference in electrophoresis index, aggregation index and rigidity index between the two groups before treatment (P> 0.05). The electrophoresis index, aggregation index and rigidity index of children in observation group after treatment were lower than those in control group (P < 0.05). The electrophoresis index, aggregation index and rigidity index of the two groups were lower than those before treatment (P <0.05). There was no significant difference in Ig G and Ig M between the two groups before treatment (P> 0.05). The Ig G and Ig M in the observation group were lower than those in the control group after treatment (P <0.05) After treatment Ig Ig, Ig M were lower than before treatment (P <0.05). Conclusion High-dose methylprednisolone combined with gamma globulin can improve the neurological function, erythrocyte and humoral immune function in children with viral encephalitis.