重组人生长激素治疗对危重症患儿免疫功能的影响

目的 研究外源性重组人生长激素(rhGH)联合低热量肠内营养支持治疗对危重症患儿免疫功能的影响.方法 选取2009年1月-2010年1月住本院PICU 60例危重症患儿(危重症组),随机分为对照治疗组(30例)和rhGH治疗组(30例).2组患儿均予肠内营养(60～80 kcal·kg-1)及综合治疗,rhGH治疗组于入院第2天晚1000起给予rhGH(0.1 IU·kg-1·d-1)腹部皮下注射,连续7 d.检测治疗前和治疗后2组患儿细胞免疫(CD3、CD4、CD8、CD4/CD8、CD19、NK细胞)和体液免疫(IgA、IgG、IgM).另选择同期健康体检婴幼儿20例作为健康对照组,检测细胞免疫和体液免疫作对照.结果 1.治疗前,危重症组CD3、CD8、NK细胞水平(56.04±12.23)%、(21.99±7.25)%、(4.42±2.67)%]显著低于健康对照组(71.57±7.27)%、(28.71±6.02)%、(12.16±6.32)%]低(Pa<0.01);治疗后,rhGH治疗组CD4、CD4/CD8、NK细胞(50.17±7.71)%、(2.57±0.98)%、(7.72±2.89)%]较对照治疗组(37.30±10.94)%、(1.47±0.79)%、(3.97±2.85)%]明显增高,差异有统计学意义(Pa<0.05).2.治疗前,危重组CD19水平(37.68±12.47)%]显著高于健康对照组(13.16±5.17)%](P<0.01);治疗后,rhGH治疗组CD19水平(20.98±4.59)%]较对照治疗组(29.77±13.58)%]明显下降(P<0.05).3.危重症组IgG、IgA、IgM水平(4.39±1.36) g·L-1、(0.24±0.18) g·L-1、(0.57±0.20) g·L-1]较健康对照组(6.28±2.14) g·L-1、(0.37±0.15) g·L-1、(0.78±0.23) g·L-1]显著下降,差异有统计学意义(Pa<0.05);rhGH治疗组IgG、IgA水平(7.26±1.98) g·L-1、(0.45±0.22) g·L-1]较对照治疗组(5.18±1.34)g·L-1、(0.29±0.15)g·L-1]明显增高,差异有统计学意义(Pa<0.05).结论 危重症患儿细胞免疫和体液免疫功能受到抑制;外源性rhGH联合低热量肠内营养支持治疗能明显改善危重症患儿免疫功能紊乱.

Effect of Recombinant Human Growth Hormone on Immunity Function in Critically Ill Patients

Objective To study the influence of recombinant human growth hormone(rhGH) combined with nutrition support on the changes of immunological function of critically ill patients.Methods Sixty critically ill patients were selected from Jan.2009 to Jan.2010,from NICU of Guiyang Children′s Hospital,who were randomly divided into 2 groups:control treatment group(30 cases) and rhGH treatment group(30 cases).These children in 2 groups received similar nutritional intakes(60-80 kcal·kg-1)and standard treament.The patiens in rhGH treatment group were given rhGH(0.1 IU·kg-1 every night,for 7 days).The levels of cellular immunity(CD3,CD4,CD4/CD8,NK cell) and humoral immunity(IgA,IgG,IgM) were detected before and after treatment.Twenty healthy infants were selected as healthy control group,and their immunity and humoral immunity levels were detected.Results 1.The levels of serum CD3,CD8 and NK cell in critically ill pediatric group (56.04±12.23)%,(21.99±7.25)%,(4.42±2.67)%] were lower than those in healthy control group (71.57±7.27)%,(28.71±6.02)%,(12.16±6.32)%] before treatment(Pa<0.01).Compared with control treatment group (37.30±10.94)%,(1.47±0.79)%,(3.97±2.85)%],rhGH treatment group had significant increasing of serum CD4,the ratio of CD4/CD8 and NK cells (50.17±7.71)%,(2.57±0.98)%,(7.72±2.89)%] after treatment(Pa<0.05).2.The level of serum CD19 was higher in critically ill group (37.68±12.47)%] than that in healthy control group (13.16±5.17)%] before treatment(P<0.01).The level of serum CD19 decreased in rhGH treatment group (20.98±4.59)%] compared with control treatment group (29.77±13.58)%] after treatment(P<0.05).3.The levels of serum IgG,IgA,IgM were lower in critically ill group (4.39±1.36) g·L-1,(0.24±0.18) g·L-1,(0.57±0.20) g·L-1] than those in healthy control group (6.28±2.14) g·L-1,(0.37±0.15) g·L-1,(0.78±0.23) g·L-1] before treatment(Pa<0.01).Compare control treatment group (5.18±1.34) g·L-1,(0.29±0.15) g·L-1],rhGH treatment group had significant increasing of serum IgG and IgA (7.26±1.98) g·L-1,(0.45±0.22) g·L-1] after treatment(Pa<0.05).Conclusions The cellar and humoral immune function are inhibited in the critically ill pediatric patients.The combination of nutrition support with rhGH can significantly improve the immunity function in the critically ill pediatric patients.