丙种球蛋白治疗RSV毛细支气管炎的临床及免疫学研究

为评估静脉注射丙种球蛋白(IVIG)治疗呼吸道合胞病毒毛细支气管炎(RSV毛支)的临床疗效及免疫学机理,比较26例IVIG治疗组和30例常规治疗组患儿症状体征消失时间及住院天数,同时检测治疗前后血清白介素6(IL-6)、白介素8(IL-8)及肿瘤坏死因子-α(TNF-α)水平。结果:与常规治疗组相比,IVIG治疗组喘憋和肺部体征消失时间明显缩短(4.0天±1.1天比5.2天±1.4天,5.4天±1.5天比6.5天±1.8天,P分别<0.001和<0.05),而住院天数则无显著差异(9.0天±2.2天比10.3天±3.1天,P>0.05)。治疗前两组患儿血清IL-6、IL-8及TNF-α水平均高于正常对照组;IVIG治疗后3种细胞因子水平明显降低.但与常规治疗组相比无显著差异。结论:细胞因子参与了RSV毛支的发病过程。IVIG治疗有较确切的临床疗效,但单剂(0.25g/kg)对血清细胞因子的抑制作用不明显。

Clinical effect and immunological mechanism of intraveneous immunoglobulin for the treatment of bronchiolitis induced by respiratory syncytial virus (RSV)

To evaluate clinical effect and immunological mechanism of intravene ous immunoglobulin (IVIG) for the treatment of bronchiolitis induced by respirat ory syncytial virus (RSV) in infants, the levels of serum interleukin 6 (IL- 6), interleukin 8 (IL-8) and tumor necrosis factor-α (TNF -α) were determined before and after IVIG therapy in 26 cases with IVIG therapy, 30 cases with the conventional therapy and 40 cases as normal controls , respectively. The recovery time of the clinical signs and symptoms and duratio n of hospitalization were also compared between the IVIG group and the conventio nal group. The results showed that the levels of IL-6, IL-8 and TNF-α were significantly higher in two groups before treatment comparin g to normal infants. These cytokines tended to decrease after IVIG therapy altho ugh no significantly difference was observed between the IVIG group and the conv entional group. It was noticed that the recovery time of clinical wheezing and l ung signs were obviously shortened in the IVIG group comparing to the convention a l group (4.0±2.1 Vs. 5.2±1.4days; 5.4±1.5 Vs. 6.5±1.8days, P ＜0.001， P＜0.05). No significantly difference of hospitalization days w as observed between two groups (9±2.2 Vs. 10.3±3.1days, P＞ 0.05). It is concluded that cytokines involves in the pathogenesis of bronchiolitis ind uced by RSV in infants, and IVIG therapy can be helpful for the improvement of t he clinical situation. However, the inhibitory effect on the production of cytok ines seems not to be obvious when single　IVIG　therapy　is given at a dose of 0.25g/kg.