静脉注射丙种球蛋白对重症肺炎患儿免疫功能的影响

目的：观察静脉注射丙种球蛋白（ IVIG）对重症肺炎患儿体液免疫及细胞免疫的影响。方法重症肺炎患儿68例作为观察对象，按照治疗方法分为IVIG组（n＝38）和对照组（n＝30）。其中IVIG组在常规综合治疗的基础上静脉滴注丙种球蛋白400 mg/（ kg·d），连续应用3 d。分别于治疗前、治疗后3、7、14 d检测患儿IgM、IgG、IgA水平，血清IL-6、TNF-α水平，CD3、CD4、CD8阳性细胞百分率及CD4/CD8比值。结果 IVIG组在治疗后3 d，IgM、IgG、IgA即较治疗前显著升高，尤其是IgG升高更为显著（P﹤0.01），而对照组较治疗前无显著变化（P﹥0.05），两组相比，IVIG组IgG、IgA显著高于对照组（ P﹤0.01）。IVIG组IL-6及TNF-α在治疗后3 d即较治疗前显著降低（ P﹤0.01），并且显著低于对照组（ P﹤0.01）；在治疗后7 d及14 d时仍较治疗前显著降低（ P﹤0.01）。CD3、CD4、CD8、CD4/CD8在IVIG组治疗后3 d起较治疗前即显著升高（ P﹤0.01），在治疗后7 d及14 d仍显著高于治疗前（P﹤0.01）；两组相比，在治疗后3 d，IVIG组均显著高于对照组（P﹤0.01）。结论 IVIG可促进重症肺炎患儿体液免疫和细胞免疫功能，有助于患儿度过重症肺炎危险期。

Effect of intravenous immunoglobulin on immune function of children with severe pneumonia

Objective To observe the effect of intravenous immunoglobulin（ IVIG ） on humoral and cellular immunity of children with severe pneumonia. Methods 68 children with severe pneumonia were divided into 2 groups：IVIG group（ n=38 ）and control group（n=30）;routine treatment was applied to children in both group,while intravenous immunoglobulin,400 mg/（kg·d）, was added to children in IVIG group for 3 days;the serum level of IgM,IgG,IgA,IL-6 and TNF-α,the positive percentage of CD3, CD4,CD8 cells and the ratio of CD4/CD8 were detected before treatment and at the time point of 3,7 and 14 days after treatment, respectively. Results 3 days after treatment,the levels of IgM,IgG,IgA of the children in IVIG group went up much higher than those before treatment,especially the level of IgG increased most obviously（P﹤0. 01）,while the levels of children in control group were of no obvious changes（P﹥0. 05）;the contrast study between the 2 groups showed that the levels of IgG and IgA in IVIG groups were much higher than those in control group（P﹤0. 01）;3,7 and 14 days after treatment,the levels of IL-6 and TNF-α of the children in IVIG group were much lower than those before treatment（P﹤0. 01）,and significant lower than those in control group;3,7 and 14 days after treatment,the positive percentage of CD3,CD4,CD8 cells and the ratio of CD4/CD8 of the children in IVIG groups increased much higher than those before treatment（P﹤0. 01）;the contrast study between the 2 groups 3 days after treatment showed that the effect in IVIG group was much superior to that in control group（P﹤0. 01）. Conclusions IVIG can promote the humoral and cellular immunity of children with severe pneumonia and can help the children to get through the risky period.