卡介苗素注射液对儿童肾病综合征继发感染预防的初步探讨

目的 观察卡介苗素注射液对小儿单纯性肾病综合征(SNS)继发感染的影响。方法38例初治SNS患儿随机分卡介苗素治疗组(Ⅰ组,n=22)和单纯强的松对照组(Ⅱ组,n=16)。2组均采用强的松中程疗法,Ⅰ组在此基础上给卡介苗素0.5mg(1ml)肌肉注射,隔天一次,疗程3～6个月。观察治疗阶段患儿8周内缓解率、继发感染率、感染控制时间、复发率及用药前和用药3个月后血清、尿可溶性白介素2受体(sIL一2R)及血浆IgG、IgA、IgM的变化。结果 Ⅰ组和Ⅱ组8周内缓解率无显著差异,继发感染率和复发率Ⅰ组均显著低于Ⅱ组。感染后治愈天数Ⅰ组显著少于Ⅱ组[(5.0±1.6)d vs(8.0±2.0)d,P<0.05]。Ⅰ组感染后有6例出现病情反复,但感染控制后尿蛋白即消失,而Ⅱ组感染后有8例复发,感染控制后尿蛋白有5例仍阳性,需恢复激素用量才转阴。血清sIL-2R用药后Ⅰ组下降显著高于Ⅱ组,与正常组比已无显著差异,而Ⅱ组仍显著高于正常组。尿sIL-2R与血清sIL-2R一样也发生上述显著变化。血浆IgG用药后Ⅰ组上升显著高于Ⅱ组,与正常组比较已无显著差异。而Ⅱ组仍显著低于正常组。血浆IgA、IgM用药前后两组比较均无差别。结论卡介苗素在佐治SNS中具有预防和降低感染、减少和预防复发、避免反复大量应用激素的作用,此机制可能在于其降低SNS患儿血、尿sIL-2R水

Preventive effect of complicated infection of children with nephritic syndrome on vaccine injection

Objective To observe the preventive effect of the complicated infection of children with simple nephrotic syndrome (SNS) on vaccine injection. Methods 38 children with SNS were randomly divided into 2 groups-vaccine treatment goup ( I group, n - 22) and prednison control group ( II group, n =16). The treatment protocol of prednison used for 6 months was administered in 2 groups, while 0. 5 mg (1 ml) vaccine injection by intramuscular injected on alternate days was added to I group for 3 to 6 months. The rates of remission within 8 weeks, complicated infection, and relapse within 3 months and the recovery time of infection were observed in I group and II group. The levels of serum and urinary soluble interleukin-2 receptro (sIL-2R) and plasma IgG, IgA, IgM were determined before and after vaccine having be used for 3 months in I group, II group and 25 cases as normal control group (III group), respectively . Results The rate of remission within 8 weeks was not different in I and II group. The rates of infection complicated and relapse within 3 months were all significantly lower in I group than those in II group. The recovery time of infection complicated was obviously shortened in I group comparing to II group. 6 cases in I group and 8 cases in II group were found proleinuria after infection, but the absence of proteinuria was immediate and did not need to increase prednison dosage in I group after controlling infection. However, II group could not so and need to recover the start dosage of prednison. The level of serum sIL-2R was significantly decreased more in I group than that in II group and did not different in I group comparing to III group, but was significantly higher in II group than that in III group after vaccine therapy.The change of urinary sIL-2R was same with serum sIL-2R.The plasma IgG was significantly increased more I group than that II group and not obviously different in I group comparing to III group but was much lower in II group than that in III group after vaccine therapy. The plasma IgA, IgM were not significantly different in three groups before and after vaccine therapy. Conclusion Vaccine therapy can be helpful for protecting from and decreasing infection, diminishing relapse and steroid dosage of children with SNS, which could be that vaccine declined the levels of serum and urinary sIL-2R and increased the level of IgG, and thus, improved their immune function.