2019 年第 8 期 第 14 卷

甲泼尼龙联合丙种球蛋白冲击治疗对手足口病患儿免疫功能的影响

Effect of methylprednisolone combined with gamma globulin pulse therapy on immunologic function in children with hand-foot-mouth disease

作者：赵允马俊岗赵维彩杜博英盖冰徐素文

英文作者：

单位：050051石家庄市第二医院儿科（赵允、赵维彩、杜博英、盖冰、徐素文）；054000河北省邢台市临城县中医院儿科（马俊岗）

英文单位：

关键词：手足口病；甲泼尼龙；丙种球蛋白冲击治疗；免疫学

英文关键词：

• 摘要：

• 【摘要】目的    探讨甲泼尼龙联合丙种球蛋白冲击治疗手足口病的效果及对患儿免疫功能的影响。方法    选取河北省石家庄市第二医院2015年6月至2018年6月收治的手足口病患儿240例，依据随机数字表法分为甲丙组和单甲组，每组120例。单甲组在常规治疗的基础上给予甲泼尼龙治疗，甲丙组在常规治疗的基础上给予甲泼尼龙联合丙种球蛋白冲击治疗。比较2组细胞免疫学指标［CD+3、CD+4、CD+8、CD+4/CD+8调节性T细胞（Treg）和辅助性T细胞17（Th17）］、体液免疫学指标［免疫球蛋白（Ig）A、IgG、IgM、IgE］、临床疗效和不良反应发生情况。结果    单甲组和甲丙组治疗后CD+3、CD+4、CD+4/CD+8、Treg、IgA、IgG、IgE明显高于治疗前，Th17、IgM明显低于治疗前；甲丙组治疗后CD+3、CD+4、CD+4/CD+8、Treg、IgA、IgG、IgE、IgM明显高于单甲组，Th17明显低于单甲组［（56±6）%比（47±5）%、（69±6）%比（56±6）%、（1.71±0.31）比（1.43±0.22）、（3.8±0.4）%比（3.4±0.4）%、（1.36±0.22）g/L比（0.99±0.15）g/L、（14.6±1.6）g/L比（10.2±1.3）g/L、（46±5）g/L比（40±4）g/L、（1.91±0.27）g/L比（1.18±0.20）g/L、（0.28±0.04）%比（0.32±0.04）%］，差异均有统计学意义（均P＜0.05）。甲丙组治疗有效率明显高于单甲组［95.0%（114/120）比85.0%（102/120）］，差异有统计学意义（χ2=6.667, P＝0.010）。2组不良反应发生率比较差异无统计学意义（P＝0.678）。结论    甲泼尼龙联合丙种球蛋白冲击治疗可有效改善手足口病患儿细胞、体液等免疫功能，有利于提高疗效，且安全性好。

• 【Abstract】Objective    To observe the curative effect of methylprednisolone combined with gamma globulin pulse therapy on children with hand-foot-mouth disease and the effect on immunologic function. Methods    Totally 240 children with hand-foot-mouth disease were enrolled from June 2015 to June 2018 in Shijiazhuang Second Hospital. They were randomly divided into M group treated by methylprednisolone alone and MG group treated by methylprednisolone plus gamma globulin pulse therapy, with 120 cases in each group. Cellular immunological indexes including CD+3, CD+4, CD+8, CD+4/CD+8, regulatory T cells(Treg) and helper T cells 17(Th17), humoral immunological indexes including immunoglobulin(Ig)A, IgG, IgM, IgE, therapeutic efficacy and adverse reactions were analyzed. Results    After treatment, CD+3, CD+4, CD+4/CD+8, Treg, IgA, IgG, IgE were significantly higher and Th17, IgM were lower than those before treatment in both groups; CD+3, CD+4, CD+4/CD+8, Treg, IgA, IgG, IgE and IgM in the MG group were significantly higher and Th17 was lower than those in the G group［（56±6）% vs （47±5）%, （69±6）% vs （56±6）%, （1.71±0.31） vs （1.43±0.22）, （3.8±0.4）% vs （3.4±0.4）%, （1.36±0.22）g/L vs （0.99±0.15）g/L, （14.6±1.6）g/L vs （10.2±1.3）g/L, （46±5）g/L vs （40±4）g/L, （1.91±0.27）g/L vs （1.18±0.20）g/L, （0.28±0.04）% vs （0.32±0.04）%］（all P＜0.05）. Effective rate in the MG group was significantly higher than that in the G group［95.0%（114/120） vs 85.0%（102/120）］（χ2=6.667, P＝0.010）. Adverse reaction rate showed no significant difference between groups(P=0.678). Conclusions    Methylprednisolone combined with gamma globulin pulse therapy treating hand-foot-mouth disease can effectively regulate cellular and humoral immune function, as well as improve the therapeutic efficacy with good safety.