大剂量免疫球蛋白治疗急性病毒性脑炎临床研究

目的探讨静脉大剂量免疫球蛋白对急性病毒脑炎的辅助治疗作用.方法 55例急性病毒性脑炎患者随机分为研究组(27例)和对照组(28例),研究组给予人免疫球蛋白(每d 0.25～0.3g/kg),连续冲击治疗5d.观察两组病人疗效、并发症、脑电图改变.结果两组病人显效率分别为51.9%和21.4%(p<0.05),有效率分别为85.2%和53.6%(p<0.05)、并发症感染分别为7.4%、32.1%(p<0.05);治疗2周后中度及重度异常脑电图比率分别为18.5%、46.4%(p<0.05).结论大剂量免疫球蛋白辅助治疗急性病毒性脑炎能提高疗效、减少并发症,值得临床推广.     

人血免疫球蛋白在病毒性脑炎治疗中的临床应用观察

目的 探究人血免疫球蛋白在临床上对病毒性脑炎的应用疗效.方法 将我院2013年8月至2014年2月收治的102例病毒性脑炎患者随机分为观察组和对照组,每组各51例,全部患者均符合病毒性脑炎的诊断标准.对照组患者给予阿昔洛韦抗病毒、止惊、降颅内压、冬眠疗法、加压氧和糖皮质激素等常规治疗,观察组患者在对照组的基础上给予人血免疫球蛋白,剂量为500mg/(kg·d),共3天,比较两组患者的治疗效果.结果 观察组患者各种临床症状的恢复时间明显少于对照组,住院时间也明显少于对照组,差异有统计学意义(P＜0.05);观察组患者在治疗后并发症的发生率和病死率明显低于对照组,差异有统计学意义(x2=18.21,P＜0.05).结论 阿昔洛韦常规联合人血免疫球蛋白可以更好地协同治疗病毒性脑炎,减少患者临床症状的恢复时间,缩短住院病程,减少并发症的发生,减轻不良反应.     

静脉注射大剂量丙种球蛋白治疗小儿重症病毒性脑炎的疗效观察

病毒性脑炎（viral encephalitis）是病毒直接感染或感染后引起脑部炎性改变,也是儿科临床比较常见的由各种病毒引起的中枢神经系统感染性疾病,临床表现缺乏特异性,危重者呈急进性过程,可导致后遗症及死亡。早期神经系统症状和体征不典型易误诊,是导致小儿死亡或造成神经系统后遗症的主要原因之一。我科用联合大剂量静脉注射丙种球蛋白的方法治疗小儿重症病毒性脑炎,取得较好的疗效,现报告如下。     

高压氧综合治疗病毒性脑炎患儿的临床研究

本文为86例临床上采用常规治疗的病毒性脑炎患儿，其中43例加用高压氧治疗作为治疗组，另43例作为对照组，观察比较两组近期和治疗后2-3年的临床疗效。结果显示：治疗组平均治愈天数为26．5±1．73天明显短于对照组41．7±2．51天（P＜0．05），有效率90．69％明显优于对照组67．44％（P＜0．01），治疗后2－3年后遗症和智能低下的发生也明显低于对照组（P＜0．05）。提示：高压氧有提高其临床疗效、减轻后遗症的作用。     

病毒性脑炎

病毒、细菌、原虫、寄生虫等多种病原体均可引起脑组织炎症。病毒性脑炎（Virus encephalitis）是指病毒感染所引起的脑实质炎症，常表现为发热、头痛、抽搐、意识障碍和脑膜刺激症状等，可致中枢神经系统局灶性损害。病毒性脑炎预后不佳，死亡率高，常留有严重后遗症，如乙型脑炎患者的后遗症可达30％。病毒也可感染脑膜出现脑膜炎（Meningitis）。脑膜炎可分为细菌性和无菌性两类。后者是指脑脊液涂片和细菌培养为隐性的脑膜炎。一般无菌性脑膜炎多为病毒感染所致，故无菌性脑膜炎和病毒性脑膜炎几乎成为同意词。病毒性脑膜炎的病程一般较短，预后较好。病毒性脑膜脑炎（Meningoencephalitis）是指脑实质和脑膜同时感染。     

病毒性脑炎脑电地形图与临床研究

目的:观察病毒性脑炎病人的脑电地形图特点及对临床治疗的指导价值。方法:自1995年2月至1999年3月间对收治资料齐全以儿童为主的53例病毒性脑炎进行BEAM首次描记及追踪观察。结果;53例中轻度异常17例(32％)中度异常24例(45％),重度异常12例(23％)。发病3～5天内阳性率57％,6～8天阳性率88％。BEAM首次描记时间在一周后阳性率及异常程度最高。结论:病毒性脑炎BEAM改变总体表现以广泛不规则高功率θ频带为主,混有部分高功率δ及杂乱波为特征。     

20世纪末新出现的病毒性脑炎--尼巴病毒性脑炎

1∫恢中碌牟《拘阅匝?998年 9月马来西亚的Ｐｅｒａｋ州发生病毒性脑炎的流行 ,许多成年人出现高热、脑炎等临床症状 ,病例急剧增加 ,截至 1999年 5月 ,共发病 2 65例 ,死亡10 5例 ,死亡率达 40 %。由于该病发病凶险 ,死亡率高 ,且病因不清 ,震惊世界[1 ] 。 1999年初 ,与马来西亚毗邻的新加坡也发现同样的脑炎病人 ,经医院确诊的病例为 11例 ,死亡 1例。同年 3月马来西亚大学的研究人员从Ｐｅｒａｋ州Ｎｉｐａｈ镇的病毒性脑炎的尸解标本中分离到 1株病毒 ,该病毒颗粒为 160～ 30 0ｎｍ ,符合副粘病毒 (Ｐａｒａｍｙｘｏｖｉｒｕｓ)形态特…     

单纯疱疹病毒性脑炎诊断和治疗的研究近况

单纯瘊疹病毒性脑炎（ＨＳＥ）是散发性病毒性脑炎中最常见、预后最差的一种，其中９５％以上的病例是ＨＳＶ－Ｉ引起的。ＨＳＥ的临床症状、体征、常用辅助检查均为非特异性的。用血清学方法检测血清中和脑脊液中ＨＳＶ－ＩｇＭ，敏感性和特异性均较差。用ＰＣＲ技术扩增脑脊液中ＨＳＶ－ＤＮＡ的方法，敏感性和特异性较高可作为ＨＳＥ确诊的依据。无环岛苷是治疗ＨＳＥ的有效药物。     

病毒性脑炎脑电地形图与临床研究

目的:观察病毒性脑炎病人的脑地形图特点及临床治疗的指导价值。方法:自2005年2月至2009年3月间对收治资料齐全以儿童为主的53例病毒性脑炎进行BEAM首次描记及追踪观察。结果:53例中轻度异常17例(32%)中度异常24例(45%),重度异常12例(23%)。发病3～5天内阳性率57%,6～8天阳性率88%。BEAM首次描记时间在一周后阳性率及异常程度最高。结论:病毒性脑炎BEAM改变总体表现以广泛不规则高功率θ频带为主,混有部分高功率δ及杂乱波为主。     

以精神症状为突出表现的病毒性脑炎动态脑电图的研究

目的 研究动态脑电图对于以精神症状为突出表现的病毒性脑炎辅助诊断价值。方法 对精神症状为突出表现，临床拟诊为病毒性脑炎的病人在入院3d内分别进行常规脑电图和动态脑电图检查，其中有40例确诊为病毒性脑炎，采用配对χ^2检验（McNemerχ^2检验）比较两种检查方法对于中度或重度异常脑电活动的机率。结果动态脑电图和常规脑电图的中度或重度脑电活动的发现率分别为：80％、65％，差异有显著性（p〈0．05）；发现痫样放电的机率分别为：42．5％、5％，差异有显著性（p〈0．005）。动态脑电图检查发现40例病人的睡眠生理波都不清楚。结论 动态脑电图对以精神症状为突出表现的病毒性脑炎早期诊断有重要的辅助诊断价值，相对于常规脑电图有更高的敏感性：睡眠节律紊乱是这类病毒性脑炎的共同特征。     

RT-PCR技术在小儿肠道病毒性脑炎诊断中的应用价值探讨

目的探讨用RT-PCR技术诊断小儿肠道病毒性脑炎的临床应用价值。方法选取我院2008-06～2009-08期间诊断为病毒性脑炎的住院患儿。于入院的当天抽取脑脊液,经RT-PCR反应,筛选出肠道病毒病例,结果用SPSS13.0进行统计。结果共有45例标本检测出肠道病毒(EV),其中,男20例,检出率76.9%;女25例,检出率83.3%;男女间差异无显著性,(P>0.05)。8月～3岁组16例,检出率80%;3～6岁组18例,检出率81.8%;6～12岁11例,检出率78.6%;各组间差异无显著性,(P>0.05)。EV感染病例与阳性对照可扩增出单一相同的电泳条带;所有阴性对照病例均无扩增。整个检测过程平均用时4.6h。结论①RT-PCR技术可以快速做出病原学诊断,且敏感性高,无非特异性扩增。②该方法操作简单,值得临床上进一步推广。③我院2008-06-2009-08期间诊断为病毒性脑炎的住院患儿以肠道病毒感染为主。④肠道病毒在小儿中为普遍易感,未见有性别及年龄差异性。     

血清sVCAM-1、NSE与Gal-9联合检测病毒性脑炎患儿病情程度变化的判定价值

目的分析血清sVCAM-1、NSE与Gal-9联合检测病毒性脑炎患儿病情程度变化的判定价值。方法选择2016年11月至2017年11月的VE患儿116例作为研究组,按照入院时的生命体征和脑干受损和呼吸抑制情况分为重症组和轻症组,接受2周治疗后,选择病情好转为恢复期的患儿进行相关研究,选择同期在我院接受体检的健康儿50例作为对照组。比较不同组和不同病程间血清sVCAM-1、NSE与Gal-9水平。结果重症组血清sVCAM-1、NSE与Gal-9水平显著高于轻症组和对照组(P<0.05)。恢复期患儿sVCAM-1、NSE较治疗前显著降低(P<0.05),其中sVCAM-1与对照组差异无统计学意义(P>0.05),Gal-9较治疗前显著升高(P<0.05)。结论 VE患儿血清sVCAM-1、NSE和Gal-9明显升高,并且病情严重患儿高于轻症患儿,处于恢复期的患儿的sVCAM-1、NSE显著降低而Gal-9明显升高。     

Intravenous immunoglobulin treatment for patients with severe COVID-19: a retrospective multicentre study

ObjectivesIntravenous immunoglobulin (IVIG) is commonly used to treat severe COVID-19, although the clinical outcome of such treatment remains unclear. This study evaluated the effectiveness of IVIG treatment in severe COVID-19 patients.MethodsThis retrospective multicentre study evaluated 28-day mortality in severe COVID-19 patients with or without IVIG treatment. Each patient treated with IVIG was matched with one untreated patient. Logistic regression and inverse probability weighting (IPW) were used to control confounding factors.ResultsThe study included 850 patients (421 IVIG-treated patients and 429 non-IVIG-treated patients). After matching, 406 patients per group remained. No significant difference in 28-day mortality was observed after IPW analysis (average treatment effect (ATE) = 0.008, 95% CI –0.081 to 0.097, p 0.863). There were no significant differences between the IVIG group and non-IVIG group for acute respiratory distress syndrome, diffuse intravascular coagulation, myocardial injury, acute hepatic injury, shock, acute kidney injury, non-invasive mechanical ventilation, invasive mechanical ventilation, continuous renal replacement therapy and extracorporeal membrane oxygenation except for prone position ventilation (ATE = –0.022, 95% CI –0.041 to –0.002, p 0.028).DiscussionIVIG treatment was not associated with significant changes in 28-day mortality in severe COVID-19 patients. The effectiveness of IVIG in treating patients with severe COVID-19 needs to be further investigated through future studies.     

北京地区病毒性脑炎患者病原体的分离和初步鉴定

１９９１年夏秋季，我们从４１例北京儿童医院临床诊断为病毒性脑炎（非乙脑）患者的７５份急性期血和／或脑脊液中分离到３３株病毒。对其中１２株进行电镜观察，电镜下均见大小相同的球形病毒颗粒，毒粒的直径约为４４．７８±１．３５ｕｍ，无囊膜，具双层蛋白外壳，视野内多见空心颗粒。超薄切片显示病毒在感染细胞的胞浆内发生，直径约为４７．６±２．３ｕｍ。正常细胞中未见病毒颗粒。对其中３株病毒进行理化性状分析，多次试验均显示该病毒抵抗５＇－碘脱氧尿苷，抵抗乙醚，耐酸，能在地鼠肾ＢＨＫ－２１和白纹伊蚊Ｃ６／３６细胞上增殖并出现细胞病变。该病毒与本室制备的披膜病毒科甲组、乙脑病毒和布尼亚病毒科的组特异性免疫腹水均不反应。脑内接种３日龄乳小白鼠可引起不规律的发病和死亡。上述结果表明，该病毒是一类４５ｕｍ左右、无囊膜、耐酸的ＲＮＡ病毒。     

Long-term Efficacy of Intravenous Immunoglobulin Therapy for Moderate to Severe Childhood Atopic Dermatitis

Purpose

The present study investigates the long-term effects of intravenous immunoglobulin (IVIg) therapy for the treatment of moderate to severe childhood atopic dermatitis (AD). Previous research indicates that IVIg can treat severe AD; however, the effectiveness of IVIg has not been confirmed in prospective, blinded clinical trials.

Methods

Forty eligible children with moderate to severe AD, as defined by the criteria of Hanifin and Rajka, were enrolled in a randomized, placebo-controlled study. After the completion of an initial screening visit (V0), the patients were randomly allocated into therapy (n=30) and control (n=10) groups (V1). Thirty children were each treated with three injections of 2.0 g/kg IVIg at 1-month intervals over a 12-week period. Ten children were treated with placebo. Assessments were conducted after each injection (V2, V3, and V4) and at 3 (V5) and 6 months (V6) after completed treatment.

Results

The disease severity index was significantly decreased at V5 compared with the value at V1 (P<0.05). There were no significant changes in the total IgE level or total eosinophil count in peripheral blood at the last injection (V4) compared with the value at V1. The interleukin (IL)-5/interferon (IFN)-γ ratio was assessed in T-helper 1 (Th1) and Th2 cells. The ratio significantly decreased between V1 and V5, after which it increased, such that the ratio at V6 was not significantly different from that at V1. Compared with the level at V1, the intercellular cell adhesion molecule-1 level at V4 did not differ significantly, but the level at V5 was lower.

Conclusions

This study suggests that IVIg therapy may clinically improve AD in patients after 3 months of therapy, but the improvement may decline by 6 months after therapy.     

Intravenous immunoglobulin (IVIG) for the therapy of autoimmune disorders

The weight of evidence from numerous clinical studies supports the use of IVIG, particularly at higher doses, in the treatment of a wide range of autoimmune disorders. Extensive experience has documented the safety of IVIG therapy but its present relatively high cost necessitates firmly establishing its efficacy. There is an acute need to define those disease states where IVIG is indicated and effective. Large-scale, possibly multicentered, clinical trials employing rigorous controls will resolve these questions. Concurrent fundamental immunologic studies will elucidate the mechanisms underlying the clinical effects. We are experiencing an exciting new era of effective immunotherapies and intravenous gamma-globulin preparations have already secured an important place in the therapeutic armamentarium. While one must guard against unsubstantiated applications, critical exploration of new uses for this unique product is warranted.     

Intravenous immunoglobulin: exploiting the potential of natural antibodies

Antibodies present in healthy conditions in the absence of deliberate immunization or infections are called natural antibodies. A significant proportion of natural antibody pool is believed to interact with self-antigens, and thus is called natural autoantibodies. Natural autoantibodies belong to IgG, IgM and IgA subclasses, and are encoded by V(D)J genes in germline configuration and bind to self molecules with varying affinities. In addition to serving in first line defense mechanism, natural antibodies participate in the homeostasis of the immune system. Intravenous immunoglobulin (IVIg) is a therapeutic preparation that contains substantial amount of natural antibodies exclusively of IgG subclass. In addition to its role in protection against pathogens in primary and secondary immunodeficiency patients, IVIg exerts a number of immunoregulatory functions through its interaction with innate and adaptive immune system and thereby imposing immune homeostasis.