大剂量静脉注射免疫球蛋白对新生儿肺炎T、B淋巴细胞功能的抑制作用

目的　观察两种剂量静脉注射免疫球蛋白（intravenous immunoglobulin，IVIG）对新生儿肺炎患儿的疗效及其免疫抑制作用，为IVIG在新生儿肺炎的应用提供依据。方法　随机选取41例新生儿肺炎患儿，分为对照组、500～700mg/kgIVIG组及1000～1200mg/kgIVIG组，后两组分别于病程第1～4天接受IVIG治疗，其余治疗三组相同。观察疗效并检测治疗前后患儿血清IgG、IgA、IgM和IgG亚类，T、B淋巴细胞增殖反应，外周血单个核细胞产生IgG亚类、IL-2、IL-4及IL-6能力。结果　两种剂量IVIG组患儿临床恢复情况与对照组相比差异无显著性。与对照组比较，大剂量IVIG组治疗后血清IgG及IgG亚类水平明显升高，但其T淋巴细胞增殖反应（40062±13274)～(24476±8241)cpm,B淋巴细胞增殖反应（1751±677)～(996±423）cpm,PBMC产生IL-2（472±201)～(185±83）ng/L及IgG

Suppressive effects of high dose IVIG on functions of T and B lymphocyte of neonates with pneumonia

Objective　To observe the therapeutic and immunosuppressive effects of intravenous immunoglobulin (IVIG) in neonates with pneumonia. Methods　 Forty-one (etus generation ranged from 36 to 41 weeks) neonates with pneumonia were randomly divided into 3 groups, with 20 neonates in control group, 15 neonates in group of lower dose IVIG in which 500-700 mg/kg IVIG infused and 6 neonates in group of higher dose IVIG in which 1 000-1 200 mg/kg IVIG infused, respectively. IVIG was administered during the 1st to 4th day of the disease onset. Serum IgG, IgM, IgA and IgG subclasses, proliferation of T and B lymphocytes, IL-2, IL-4 and IL-6 produced by PBMC in vitro, IgG subclass levels in PBMC culture supernatants were detected by ELISA and 3 H-TdR incorporation assay respectively before and 2-4 days after IVIG treatment. Results　There is no clinical differentiation in all neonates with pneumonia to be observed. Serum IgG and IgG subclass levels in two IVIG groups increased markedly. However, proliferation of T (40 062±13 274) cpm～(24 476±8 241) cpm and B lymphocyte (1 751±677) cpm～(996±423) cpm, IL-2 (472±201) ng/L～(185±83) ng/L, IgG1(602±288) μg/L～(378±126) μg/L, IgG2(304±107) μg/L～(169±68) μg/L and IgG3(71±30) μg/L～(43±19) μg/L productions in higher dose IVIG group decreased significantly after IVIG treatment compared with other groups. Conclusion　It′s unlikely that IVIG treatment in favor of neonatal pneumonia. Due to its suppressive effects on functions of T and B lymphocytes at least in short term, the authors advise that its uses in neonatal infections be decided by the functional situation of neonate′s immune system and abusing of IVIG be forbidened.