林建英

【摘要】 目的 探討地塞米松對(duì)乙型腦炎患兒的病情、預(yù)后及腦脊液α-腫瘤壞死因子(TNF-α)與干擾素(IFN)的影響。方法 把33例重型極期乙腦患兒隨機(jī)分為兩組,地塞米松組18例給予靜脈地塞米松針4~5 d; 對(duì)照組15例則不用地塞米松。觀察比較兩組的臨床過程和腦脊液TNF-α與IFN的變化。結(jié)果 入院時(shí)兩組的主要臨床特點(diǎn)和腦脊液TNF-α與IFN的水平相似, 4~5 d后地塞米松組的臨床癥狀改善情況優(yōu)于對(duì)照組,但兩組的腦脊液TNF-α與IFN的水平卻無明顯改變,并經(jīng)過1個(gè)月的觀察地塞米松組的恢復(fù)期癥狀發(fā)生率也低于對(duì)照組。結(jié)論 對(duì)重型極期乙腦患兒給予靜脈地塞米松可以改善病情,減輕癥狀,減少恢復(fù)期癥狀的發(fā)生。

【關(guān)鍵詞】乙腦; 地塞米松; 病情; 預(yù)后; TNF-α; IFN

Effect of adrenal cortical hormone on the severe type of patients with epidemic encephalitis B

LIN Jian-ying.

The First Affiliated Hospital of Henan Medical University,xinxiang, 453100,China

【Abstract】 Objective To investigate the influence of adrenal cortical hormone on the patients condition, prognosis and the levels of TNF-α and TNF-γ in cerebrospinal fluid in children with epidemic encephalitis B.Methods 33 cases of severe type of patients with epidemic encephalitis B were divided into two groups randomly, i e dexamethasone-treated group (18) and the control group(15) . In the treated group, patients were treated with intravenous injection of dexamethasone at a dosage of 8 mg/(kgday） for 0.4~0.8 or 5 days; while in the control, no dexammethasone was given. The clinical courses and the changes on levels of TNF-α and IFN-γ in cerebrospinal fluid were compared between these two groups of patients.Results It was demonstrated that the clinical courses and the levels of cytokines in cerebrospinal fluid at time of admission appeared to be similar, however, the improvement of clinical course in the-treated group was better than those of the control group. As to the levels of cytokines in cerebrospinal fluid, there were no significant difference between these two groups. In addition, after one month observation, the rate of symptom development in the convalescence of the treated group was lower than that of the control group.Conclusion From the above observations, it is evident that treatment with intravenous injection of dexamethasone in severe cases with epidemic encephalitis B can improve the clinical course, lessen the clinical symptoms and reduce the rate of development of symptoms in convalescence.

【Key words】 Epidemic encephalris B; Dexamethasone; Patients condition; Prognosis; Tumor

necrosis factor-α; Interferon

流行性乙型腦炎(epidemic encephalitis B,簡(jiǎn)稱乙腦)由乙型腦炎病毒引起的以腦實(shí)質(zhì)炎性反應(yīng)為主要病變的人獸共患的急性傳染病;重型患兒病死率仍在10%左右,并且多數(shù)發(fā)生在極期。由于乙腦沒有特效的治療方法,主要是積極對(duì)癥治療和護(hù)理。目前激素在乙腦中的作用仍有不同看法,Hoke等^［1］報(bào)道使用大劑量激素沒有滿意療效;而何時(shí)軍等^［2］報(bào)道大劑量激素能抑制顱內(nèi)炎癥反應(yīng)水平,阻止病情惡化。因此激素的應(yīng)用及其作用機(jī)制有待進(jìn)一步探討。

1 材料與方法

1.1 一般資料 33例重型乙腦患兒均來自2007年11~12月新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院感染科住院病例?；純貉逡夷X特異性IgM抗體均陽性,符合乙腦診斷及分型標(biāo)準(zhǔn)^［3］。將33例隨機(jī)分為地塞米松組18例,男10例,女8例;對(duì)照組15例,男9例,女6例;年齡2~11歲。

1.2 方法 兩組年齡、最高體溫、GCS評(píng)分及腦脊液TNF-α與IFN水平均具可比性,見表1。地塞米松組給予靜脈地塞米松針0.4~0.8 mg/(kgd),2次/d，4~5 d;對(duì)照組則不用地塞米松;其余治療相同。停用地塞米松后比較兩組最高體溫、GCS評(píng)分及腦脊液TNF-α與IFN水平;極期后經(jīng)過1個(gè)月觀察比較恢復(fù)期癥狀的發(fā)生率。TNF-α與IFN檢測(cè)采用ELISA法,試劑盒購(gòu)自深圳晶美生物工程有限公司,按說明書操作。

1.3 統(tǒng)計(jì)學(xué)方法 采用SPSS 14.0軟件包進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料用t檢驗(yàn),計(jì)數(shù)資料用χ²檢驗(yàn)。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

經(jīng)治后,地塞米松組的最高體溫明顯低于對(duì)照組,GCS評(píng)分則明顯高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義,地塞米松組恢復(fù)期癥狀發(fā)生率要低于對(duì)照組,但差異無統(tǒng)計(jì)學(xué)意義,兩組的腦脊液TNF-α與IFN的水平卻無明顯改變,差異無統(tǒng)計(jì)學(xué)意義,見表2、3。