更昔洛韦联合丙种球蛋白对单纯疱疹病毒性脑炎患儿炎性因子与神经相关蛋白表达的影响

目的 观察更昔洛韦联合丙种球蛋白对单纯疱疹病毒性脑炎患儿炎性因子与神经相关蛋白表达水平的影响,以揭示其作用机制。方法 采用随机数字表法将西安市儿童医院2014年1月至2019年12月收治的174例单纯疱疹病毒性脑炎患儿分为对照组87例和研究组87例。对照组采用更昔洛韦治疗,研究组采用更昔洛韦联合丙种球蛋白治疗。观察两组的临床疗效、临床症状及体征改善时间、住院时间。并检测治疗前后两组的血清炎性因子白细胞介素-6(IL-6)、脑源性神经营养因子(BDNF)]及神经相关蛋白神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)及β-内啡肽(β-EP)]的表达水平。结果 与对照组相比,研究组退热、肢瘫恢复、惊厥控制、颅内高压控制、意识清醒、脑膜刺激征恢复的时间均显著更短,且住院时间也显著更短,差异均具有统计学意义(P＜0.001)。研究组总有效率、治愈率、显效率显著高于对照组,有效率和无效率显著低于对照组,且差异具有统计学意义(P＜0.05)。治疗前两组间IL-6、BDNF、NSE、MBP、β-EP表达水平的差异均无统计学意义(P＜0.05);与治疗前相比,治疗后研究组血清IL-6、NSE、β-EP和MBP表达水平显著降低,BDNF水平显著升高,且差异均有统计学意义(P＜0.05);治疗后,与对照组相比,研究组血清IL-6、NSE、β-EP和MBP表达水平显著降低,BDNF水平显著提高,且差异均有统计学意义(P＜0.001)。结论 单纯疱疹病毒性脑炎给予更昔洛韦联合丙种球蛋白治疗优于单一药物治疗,疗效确切,起效快,且能缩短住院时间。提示两者的协同效应可能是通过调节患儿机体炎性反应、脑源性神经营养因子及神经相关蛋白表达来缓解各临床症状及体征,安全可靠。

Effect of ganciclovir combined with gammaglobulin on levels of inflammatory cytokines and neuro-associated protein in children with herpes simplex virus encephalitis

Objective To observe the effect of ganciclovir combined with gammaglobulin on inflammatory factors,brain-derived neurotrophic factor,and neuro-associated protein in children with herpes simplex virus encephalitis,and further reveal the mechanism of its curative effect. Methods 174 children with herpes simplex virus encephalitis were collected in Xi'an Children's Hospital from January 2014 to December 2019,and divided into control group with 87 cases and research group with 87 cases by random number table.On the basis of basic treatment after admission, the control group was treated with ganciclovir,and the research group was given ganciclovir combined with gammaglobulin.The clinical efficacy,improvement time of clinical symptoms and signs,length of stay,and expression level of inflammatory factors (Interleukin-6,IL-6),brain-derived neurotrophic factor (BDNF),and neuro-associated protein (Neuron-specific enolase,NSE; Myelin basic protein,MBP; Beta-endorphin,β-EP) were compared in children with herpes simplex virus encephalitis. Results Compared with the control group,the research group showed significantly shorter in the recovery time for defervescence,limb paralysis,convulsion,intracranial hypertension,consciousness,and meningeal stimulation (P＜0.001).The total effective rate,cure rate,and significant rate of the study group were significantly higher than those of the control group,and the effective rate and inefficiency were significantly lower than those of the control group,and the difference was statistically significant (P＜0.05).Compared with before treatment,serum IL-6,NSE,β-EP and MBP expression levels in the study group significantly decreased after treatment,and BDNF levels increased significantly,and the differences were statistically significant (P＜0.05); After treatment,compared with the control group,the serum IL-6,NSE,β-EP and MBP expression levels in the study group were significantly lower,and the BDNF levels were significantly higher,and the differences were statistically significant (P＜0.001). Conclusion Ganciclovir combined with gammaglobulin in treatment of children with herpes simplex virus encephalitis is superior to single drug therapy,with definite efficacy,rapid onset,and greatly shortened hospital stay.It suggests that the synergistic effect of ganciclovir combined with gammaglobulin may be to alleviate the clinical symptoms and signs by regulating the expression of inflammatory response,brain-derived neurotrophic factor and neuro-related proteins in children,which is safe and reliable.