免疫球蛋白治疗儿童癫痫的疗效及机制分析

目的 对静脉注射免疫球蛋白(INIG)临床治疗儿童癫痫的疗效及可能机制进行分析,为临床应用IVIG治疗儿童癫痫提供依据.方法 回顾性分析98例癫痫患儿应用IVIG治疗癫痫的疗效、耐受性、安全性及治疗前后的免疫指标改变.免疫指标包括淋巴细胞亚群和血清免疫球蛋白,前者用流式细胞仪检测,后者用免疫比浊法检测.设健康体检儿童66例为对照组,测定其免疫指标.结果 IVIG治疗癫痫总体治疗有效率为78.57%.部分发作有效率为77.27%,全面发作有效率为79.63%.两者差异无统计学意义(P>0.05).特发性癫痫有效率68.09%,症状性癫痫有效率为88.23%,差异有统计学意义(P<0.05).首次单药治疗组有效率89.29%,二次单药组有效率69.23%,添加治疗组有效率75.43%,3组间差异无统计学意义(P>0.05).45例头颅MRI异常的患儿治疗后半年复查,31例病灶有改善,总有效率为68.89%;13例患者出现药物副作用,发生率为13.27%,但症状轻微,没有因不能耐受而停用的情况.治疗前,癫痫组CD19~+B、CD20~+B细胞比例较对照组增高,CD3~+CD4~+T细胞比例较对照组低,差异有统计学意义(P<0.05).治疗后CD19~+B和CD20~+B细胞比例较治疗前明显降低,差异有统计学意义(P<0.05);而CD3~+CD4~+较治疗前明显升高,差异有统计学意义(P<0.05).治疗后3周末、6个月时2组患儿的血清IgG水平明显增高,与治疗前比较差异有统计学意义(P<0.05).结论 IVIG对癫痫患儿增高的CD19~+B和CD20~+B细胞有下调作用,对伴有免疫紊乱的症状性癫痫有较好的疗效.

Therapeutic effect of intravenous immunoglobulin and its mechanism on children with epilepsy

Objective To explore the therapeutic effect of intravenous immunoglobulin(IVIG)on children with epilepsy and its mechanism to provide evidence for clinical application of IVIG into the management of children with epilepsy.Methods We retrospectively reviewed the data of 98 children with childhood-onset epilepsy treated with IVIG.Sixty-six health children were chosen as control group.The efficacy,tolerability,safety and serum immunological parameters of these patients were mainly evaluated and the serum immunologicla parameters,including T-1ymphocyte subsets and serum immunoglobulin,were detected by flow cytometry and immunoturbidimetry,respectively.Results The total effective rotes were 78.57%.Partial seizures-free rate(77.27%)and generalized seizures-free rate(79.63%)were not statistically different(P>0.05).The effective rate of symptomatic epilepsy (88.23%)and that of idiopathic epilepsy(68.09%)were significantly different(P<0.05).No significant difference of effective rates was found among the patients with new onset epilepsy having IVIG as first-line treatment(89.29%),the patients with monotherapy of MG after withdrawing AEDs(69.23%)and the patients with IVIG adjunct to other AEDs(75.43%,P>0.05).Thirty-one out of 45 patients with abnormal MRI on the brain showed improvement 6 months after treatment with IVIG.Thirteen patients had drug reactions,but could be tolerable for all these patients.Compared with the control group,epileptic groups showed significantly increased expressions of CD19~+B and CD20~+B cells and significantly decreased CD3~+CD4~+T cells.After the treatment with IVIG,epileptic groups showed significantly decreased expressions of CD19~+B and CD20~+B cells and significantly increased CD3~+CD4~+T cells as compared with the epileptic groups before the treatment.Three weeks and six months after the IVIG treatments,the level of serum IgG in the epileptic groups was significantly elevated as compared with that before treatment.Conclusion IVIG treatment,decreasing the expressions of CD19~+B and CD20~+B,is effective in treating patients with symptomatic epilepsy following immune disorders.